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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2012 Agosto;78(8):910-9
Ascites characterizes perioperative clinical indices better than preoperative body mass index. A study in orthotopic liver transplant candidates
Vater Y. 1, Dembo G. 1, Martay K. 1, Vitin A. 1, Amar E. 2, Weinbroum A. A. 2 ✉
1 Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA;
2 Post Anesthesia Care Unit, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
BACKGROUND: Preoperative body mass index (pre-BMI) affecting patients’ recovery from orthotropic liver transplantation (OLT) is controversial. Pre-BMI measurements may be exaggerated by ascites. Aim of the study was the assessment of early outcome associated with pre-BMI and ascites.
METHODS: Postoperative BMI values and ascites volumes of 206 patients undergoing OLT (2006-2007) were reviewed.
RESULTS: There were 141 preoperatively “non-obese” patients (pre-BMI ≤30 kg/m2) and 65 “obese” patients (pre-BMI >30 kg/m2). Demographics and model for end-stage liver disease scores were similar for both groups. The mean volume of ascites removed from the “non-obese” patients was significantly larger compared to the “obese” ones (P=0.018). Seventeen “obese” patients became “non-obese” postoperatively. The duration of anesthesia, ischemia, surgery, hemodynamic parameters, estimated blood loss and transfused products were similar for both groups. Ascites volumes correlated significantly (P<0.05) with various intraoperative indices but not pre-BMI. At 24 h postoperatively, the extubation rate was better for the “obese” group (99%) versus the “non-obese” group (93%, P=0.03). However, “non-obese” patients were extubated earlier than the “obese” both by 6 h (45% versus 22%, respectively, P<0.01) and by 12 h (88% versus 74%, respectively, P=0.012). The postoperative, but not the preoperative BMI, correlated with extubation rate ≤6 h (r=0.924, P=0.0001). No “obese” patients died <1 month postoperatively, compared to 9 “non-obese“ patients (P<0.01). Intensive Care Unit and hospital stay were ~25% longer for the “obese” group.
CONCLUSION: Pre-OLT BMI does not correlate with ascites or postoperative BMI, nor does it affect duration of ventilation, especially <6 h after surgery. These results dissociate ascites from pre- and post-OLT.