Obesity is Associated with Significantly More Anastomotic Leaks After Minimally Invasive Esophagectomy: A NSQIP Database Study

Background: This study assessed the association between obesity status and postoperative outcomes for patients who underwent transthoracic esophagectomy (TTE) or transhiatal esophagectomy (THE) via an open or minimally invasive (MIE) surgical approach. Methods: The 2016–2018 national surgical quality improvement program esophagectomy-targeted database was used to identify adult patients who underwent TTE or THE, with stratification of patients by obesity status and surgical approach. Using a multivariable regression model for each outcome, the study evaluated whether the adjusted difference between obese and non-obese patients varied between the open and MIE approaches. Results: In this study, 1260 patients underwent TTE (28.1% obese; 51.7% MIE), and 386 patients underwent THE (29.3% obese; 43.0% MIE). The obese patients in the TTE cohort who underwent MIE had 3.4 times higher odds of failing to wean from mechanical ventilation within 48 h (95% confidence interval [CI] 1.8–6.4), 1.7 times greater odds of returning to the operating room (95% CI 1.1– 3.0), 2.4 times greater odds of having an index hospital stay longer than 30 days, (95% CI 1.0–6.0), and 2.5 times greater odds of experiencing a grade 3 anastomotic leak (95% CI 1.3–4.9). No differences between obese and non-obese patients were observed among those who underwent TTE via an open approach or THE. Conclusions: The findings showed that obese patients undergoing TTE via an MIE approach had greater odds of failing to wean from mechanical ventilation within 48 h, returning to the operating room, having an index hospital stay longer than 30 days, and having a grade 3 anastomotic leak. These results are in contrast to the previously published literature and require replication as additional data become available.