Effect of Preoperative Body Mass Index on Surgical Textbook Outcomes Following Curative-intent Resection for Perihilar Cholangiocarcinoma

Background: & Objects: A comprehensive evaluation of the performance during the perioperative period is essential to provide good surgical care. To incorporate numerous characteristics into a single specified quality indicator, "Textbook outcomes (TO)" has been presented. The effect of the preoperative body mass index (BMI) on the occurrence of achieving/not achieving TO (non-TO) among patients having curative-intent resection for perihilar cholangiocarcinoma (pCCA) was studied. Methods This cohort study enrolled patients who underwent curative-intent resection for pCCA between 2014 and 2018 from a multicentre database. All cohort patients were classified into three groups according to the preoperative BMI: normal BMI (18.5 ~ 24.9 kg/m 2 ), low BMI (≤ 18.4 kg/m 2 ), and high BMI (≥ 25.0 kg/m 2 ). The occurrences of non-TO among the above groups were compared. Univariable and multivariable logistic analyses were used to determine whether there was any significant effect of the preoperative BMI on non-TO. Results A total of 313 patients were enrolled in this study, and 212 (67.7%), 46 (14.7%), and 55 (17.6%) were in the normal-BMI, low-BMI, and high-BMI groups, respectively. In all patients, the occurrence of non-TO was 71.6%, and the occurrence of non-TO in both the high- and low-BMI groups was significantly higher than that in the normal-BMI group (85.5% and 82.6% vs. 65.6%, both P  < 0.01). The multivariable logistic analyses indicated that both high BMI and low BMI were independently associated with a greater occurrence of non-TO (OR: 2.517, 95CI: 1.052–6.021, P = 0.038; OR: 3.379, 95CI: 1.423–8.022, P = 0.006). Conclusions More than two-thirds of the patients following curative-intent resection for pCCA did not achieve surgical TO. In addition, both preoperative high BMI and low BMI were independently associated with a higher risk of not achieving surgical TO following curative-intent resection for pCCA.