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The Interaction between Diabetes, Body Mass Index, Hepatic Steatosis, and Risk of Liver Resection: Insulin Dependent Diabetes Is the Greatest Risk for Major Complications.

Wiggans MG, Lordan JT, Shahtahmassebi G, Aroori S, Bowles MJ, Stell DA - HPB Surg (2014)

Bottom Line: Only insulin dependent diabetes was a risk factor for major complications (P = 0.028).Conclusions.Liver surgery in the presence of steatosis, elevated BMI, and non-insulin dependent diabetes is not associated with major complications.

View Article: PubMed Central - PubMed

Affiliation: Hepatopancreatobiliary Surgery, Plymouth Hospitals NHS Trust, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK ; Peninsula College of Medicine and Dentistry, University of Exeter and Plymouth University, John Bull Building, Plymouth, Devon PL6 8BU, UK.

ABSTRACT
Background. This study aimed to assess the relationship between diabetes, obesity, and hepatic steatosis in patients undergoing liver resection and to determine if these factors are independent predictors of major complications. Materials and Methods. Analysis of a prospectively maintained database of patients undergoing liver resection between 2005 and 2012 was undertaken. Background liver was assessed for steatosis and classified as <33% and ≥33%. Major complications were defined as Grade III-V complications using the Dindo-Clavien classification. Results. 504 patients underwent liver resection, of whom 56 had diabetes and 61 had steatosis ≥33%. Median BMI was 26 kg/m(2) (16-54 kg/m(2)). 94 patients developed a major complication (18.7%). BMI ≥ 25 kg/m(2) (P = 0.001) and diabetes (P = 0.018) were associated with steatosis ≥33%. Only insulin dependent diabetes was a risk factor for major complications (P = 0.028). Age, male gender, hypoalbuminaemia, synchronous bowel procedures, extent of resection, and blood transfusion were also independent risk factors. Conclusions. Liver surgery in the presence of steatosis, elevated BMI, and non-insulin dependent diabetes is not associated with major complications. Although diabetes requiring insulin therapy was a significant risk factor, the major risk factors relate to technical aspects of surgery, particularly synchronous bowel procedures.

No MeSH data available.


Related in: MedlinePlus

Box plot of body mass index (BMI), diabetic status, and degree of hepatic steatosis in 439 patients undergoing liver resection. Nil versus <33% (P < 0.001), <33 versus ≥33% (P = 0.001).
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fig1: Box plot of body mass index (BMI), diabetic status, and degree of hepatic steatosis in 439 patients undergoing liver resection. Nil versus <33% (P < 0.001), <33 versus ≥33% (P = 0.001).

Mentions: Histopathological examination revealed zero, mild, moderate, and severe steatosis in 199 (39.5%), 179 (35.5%), 54 (10.7%), and seven (1.4%) patients, respectively. Degree of steatosis was not recorded in 65 patients (12.9%). The distribution of BMI, diabetes, and steatosis is shown in Figure 1. The median BMI of patients with no steatosis (25 kg/m2, range 16–45) was lower than those with mild steatosis (27 kg/m2, range 18–44) (P < 0.001), which was lower than patients with moderate/severe steatosis (29 kg/m2, range 22–42) (P = 0.001). The median BMI of diabetic patients was 29 kg/m2 (16–40) compared to 26 kg/m2 (17–54) in nondiabetic patients (P = 0.002). There was no difference in the median BMI of patients with insulin dependent diabetes (IDDM) (29 kg/m2, range 16–40) and those with non-insulin dependent diabetes (NIDDM) (29 kg/m2, range 20–39) (P = 0.816). The rate of mild steatosis among diabetics was 16/52 (30.8%) compared to 45/387 (11.6%) in nondiabetics (P = 0.001), but there was no significant difference in the rates of mild steatosis in patients with NIDDM (11/37) and those with IDDM (5/15). The rate of moderate/severe steatosis was 6/135 (4.4%) in normal weight, nondiabetic patients, 39/249 (15.6%) in overweight nondiabetics (P = 0.001), 0/12 in normal weight diabetics, and 15/39 (38.5%) in overweight diabetics (P < 0.001).


The Interaction between Diabetes, Body Mass Index, Hepatic Steatosis, and Risk of Liver Resection: Insulin Dependent Diabetes Is the Greatest Risk for Major Complications.

Wiggans MG, Lordan JT, Shahtahmassebi G, Aroori S, Bowles MJ, Stell DA - HPB Surg (2014)

Box plot of body mass index (BMI), diabetic status, and degree of hepatic steatosis in 439 patients undergoing liver resection. Nil versus <33% (P < 0.001), <33 versus ≥33% (P = 0.001).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4150432&req=5

fig1: Box plot of body mass index (BMI), diabetic status, and degree of hepatic steatosis in 439 patients undergoing liver resection. Nil versus <33% (P < 0.001), <33 versus ≥33% (P = 0.001).
Mentions: Histopathological examination revealed zero, mild, moderate, and severe steatosis in 199 (39.5%), 179 (35.5%), 54 (10.7%), and seven (1.4%) patients, respectively. Degree of steatosis was not recorded in 65 patients (12.9%). The distribution of BMI, diabetes, and steatosis is shown in Figure 1. The median BMI of patients with no steatosis (25 kg/m2, range 16–45) was lower than those with mild steatosis (27 kg/m2, range 18–44) (P < 0.001), which was lower than patients with moderate/severe steatosis (29 kg/m2, range 22–42) (P = 0.001). The median BMI of diabetic patients was 29 kg/m2 (16–40) compared to 26 kg/m2 (17–54) in nondiabetic patients (P = 0.002). There was no difference in the median BMI of patients with insulin dependent diabetes (IDDM) (29 kg/m2, range 16–40) and those with non-insulin dependent diabetes (NIDDM) (29 kg/m2, range 20–39) (P = 0.816). The rate of mild steatosis among diabetics was 16/52 (30.8%) compared to 45/387 (11.6%) in nondiabetics (P = 0.001), but there was no significant difference in the rates of mild steatosis in patients with NIDDM (11/37) and those with IDDM (5/15). The rate of moderate/severe steatosis was 6/135 (4.4%) in normal weight, nondiabetic patients, 39/249 (15.6%) in overweight nondiabetics (P = 0.001), 0/12 in normal weight diabetics, and 15/39 (38.5%) in overweight diabetics (P < 0.001).

Bottom Line: Only insulin dependent diabetes was a risk factor for major complications (P = 0.028).Conclusions.Liver surgery in the presence of steatosis, elevated BMI, and non-insulin dependent diabetes is not associated with major complications.

View Article: PubMed Central - PubMed

Affiliation: Hepatopancreatobiliary Surgery, Plymouth Hospitals NHS Trust, Derriford Hospital, Derriford Road, Plymouth, Devon PL6 8DH, UK ; Peninsula College of Medicine and Dentistry, University of Exeter and Plymouth University, John Bull Building, Plymouth, Devon PL6 8BU, UK.

ABSTRACT
Background. This study aimed to assess the relationship between diabetes, obesity, and hepatic steatosis in patients undergoing liver resection and to determine if these factors are independent predictors of major complications. Materials and Methods. Analysis of a prospectively maintained database of patients undergoing liver resection between 2005 and 2012 was undertaken. Background liver was assessed for steatosis and classified as <33% and ≥33%. Major complications were defined as Grade III-V complications using the Dindo-Clavien classification. Results. 504 patients underwent liver resection, of whom 56 had diabetes and 61 had steatosis ≥33%. Median BMI was 26 kg/m(2) (16-54 kg/m(2)). 94 patients developed a major complication (18.7%). BMI ≥ 25 kg/m(2) (P = 0.001) and diabetes (P = 0.018) were associated with steatosis ≥33%. Only insulin dependent diabetes was a risk factor for major complications (P = 0.028). Age, male gender, hypoalbuminaemia, synchronous bowel procedures, extent of resection, and blood transfusion were also independent risk factors. Conclusions. Liver surgery in the presence of steatosis, elevated BMI, and non-insulin dependent diabetes is not associated with major complications. Although diabetes requiring insulin therapy was a significant risk factor, the major risk factors relate to technical aspects of surgery, particularly synchronous bowel procedures.

No MeSH data available.


Related in: MedlinePlus