Surgical Complications in Patients With Morbid Obesity Undergoing Laparoscopic Cholecystectomy: A Retrospective Cohort Study

AIM: Few studies have compared surgical outcomes across different grades of obesity. We assessed the effect of severe obesity (SO) on operative time, intraoperative blood loss >100 mL and length of hospital stay (LOS) after laparoscopic cholecystectomy (LC). METHODS: This retrospective cohort study included 1126 patients aged 14 years or older who underwent LC at Dr. Soliman Fakeeh Hospital between January 2019 and December 2021. Patients were grouped according to the presence or absence of SO, defined as a body mass index (BMI) ≥40 kg/m2 or ≥35 kg/m2 in patients with obesity-related comorbidities. Demographic, clinical, operative, and postoperative data were compared between groups. Categorical variables were analyzed using Pearson’s chi-square or Fisher’s exact tests, while continuous variables were analyzed using either the independent Student’s t-test or Mann–Whitney U test according to data distribution. Additional multivariable linear and logistic regression analyses were performed to identify whether SO was independently associated with operative time, intraoperative blood loss >100 mL, and LOS. RESULTS: Severe obesity was identified in 16.1% (181/1126) of patients. Patients with SO had significantly longer symptom duration and operative times than those without SO (4.00 (2.00–24.00) vs. 4.00 (2.00–12.00), p = 0.007; and 53.5 (39.75–75.5) vs. 48.0 (36.0–65.0) min, p = 0.004, respectively). The SO− group had significantly higher rates of endoscopic retrograde cholangiopancreatography (ERCP) and biliary stenting, whereas the difference in obstructive jaundice was not statistically significant. Intraoperative blood loss >100 mL occurred more frequently in the SO+ group (3.3% vs. 0.5%, p = 0.004). LOS was also significantly longer among SO+ (2.0 (2.0–3.0) vs. 2.0 (2.0–3.0), p = 0.003). In multivariable linear regression analysis, SO remained independently associated with longer operative time (B = 7.48 minutes, 95% CI 2.54–12.42, p = 0.003). Multivariable logistic regression analysis also demonstrated that SO was independently associated with increased odds of intraoperative blood loss >100 mL (odds ratio [OR] = 30.79, 95% CI 5.07–187.03, p < 0.001). However, SO was not independently associated with prolonged LOS after adjustment for clinically relevant covariates (B = 0.127, 95% confidence interval‌ [CI] –0.046 to 0.300, p = 0.149). CONCLUSIONS: Patients with SO undergoing LC experienced longer operative times and higher rates of intraoperative blood loss >100 mL; however, severe obesity was not independently associated with prolonged hospital stay. Multivariable analyses demonstrated that SO remained independently associated with operative time and bleeding risk after adjustment for clinically relevant covariates. These findings suggest that SO is associated with longer operative time and an increased likelihood of intraoperative bleeding during LC, although its association with postoperative outcomes appears limited. Larger prospective studies are needed to further clarify the independent effects of SO on surgical outcomes.