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Peer-reviewedCC BY 4.0Langenbeck's Archives of Surgery

Perioperative weight gain (ΔWeight): an independent predictor of major complications after major digestive surgery

  • Maximilien Ravenel1
  • Asaad Khadda1
  • Emilie Zhu1,2
  • Laura Didisheim1,2
  • Gaëtan-Romain Joliat1,2
  • Stéphanie Gonvers1,2
  • David Fuks1,2
  • Fabian Grass1,2
  • Dieter Hahnloser1,2
  • Martin Hübner1,2
  • Styliani Mantziari1,2
  • Emmanuel Melloul1,2
4 more authors
  • Markus Schäfer1,2
  • Hugo Teixeira1,2
  • Emilie Uldry1,2
  • Ismail Labgaa1,2
  1. 1Faculty of Biology & Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
  2. 2Department of Visceral Surgery, Lausanne University Hospital (CHUV), Rue du Bugnon 46, Lausanne, CH-1011 Switzerland
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Abstract

Purpose: Prediction of major complications (mPOC) after major digestive surgery (MDS) remains challenging. Perioperative gain of weight (ΔWeight) was identified as a promising marker of morbidity after specific types of surgery. This study aimed to assess the predictive value of ΔWeight for mPOC after MDS.

Methods: Retrospective analysis of consecutive patients undergoing MDS between 2013 and 2022. MDS was defined as elective surgery with anticipated duration of ≥ 120 min. Test variable was postoperative weight change calculated on postoperative day 2, defined as ΔWeight. Complications were graded according to Clavien classification. Primary outcome was mPOC (grades > II). Secondary outcomes were overall complications, Comprehensive Complication Index (CCI) and specific subtypes of complications.

Results: A total of 1402 patients were included. MPOC were reported in 392 (27.9%). Median ΔWeight was 2.0 kg [0.4–3.8]. Area under the curve (AUC) of ΔWeight for mPOC was 0.614 (p < 0.001) and maximal Youden index determined a cut-off of 2.6 kg, yielding a negative predictive value of 79%. Patients with ΔWeight above this cut-off showed higher rates of mPOC (38.2 vs. 20.7%, p < 0.001), overall complications (76.2 vs. 47.2%, p < 0.001), anastomotic leak (9.2 vs. 5.0%, p = 0.002), and higher CCI (33.7 vs. 29.6, p < 0.001). Multivariable analysis identified ΔWeight ≥ 2.6 kg as an independent predictor of mPOC (OR, 1.49; 95% CI, 1.03–2.16; p = 0.033).

Conclusion: ΔWeight emerged as a risk-stratification marker across complication types and an independent predictor of major postoperative complications after MDS. This supports perioperative weight monitoring, proactive mitigation of postoperative weight gain, and future studies developing multiparametric prediction tools.

Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00423-026-04054-x.

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Cite

BibTeXRIS
BibTeX
@article{ravenel2026perioperative,
  title = {{Perioperative weight gain (ΔWeight): an independent predictor of major complications after major digestive surgery}},
  author = {Maximilien Ravenel and Asaad Khadda and Emilie Zhu and Laura Didisheim and Gaëtan-Romain Joliat and Stéphanie Gonvers and David Fuks and Fabian Grass and Dieter Hahnloser and Martin Hübner and Styliani Mantziari and Emmanuel Melloul and Markus Schäfer and Hugo Teixeira and Emilie Uldry and Ismail Labgaa},
  journal = {Langenbeck's Archives of Surgery},
  year = {2026},
  month = jul,
  doi = {10.1007/s00423-026-04054-x},
  url = {https://doi.org/10.1007/s00423-026-04054-x},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Perioperative weight gain (ΔWeight): an independent predictor of major complications after major digestive surgery
AU  - Maximilien Ravenel
AU  - Asaad Khadda
AU  - Emilie Zhu
AU  - Laura Didisheim
AU  - Gaëtan-Romain Joliat
AU  - Stéphanie Gonvers
AU  - David Fuks
AU  - Fabian Grass
AU  - Dieter Hahnloser
AU  - Martin Hübner
AU  - Styliani Mantziari
AU  - Emmanuel Melloul
AU  - Markus Schäfer
AU  - Hugo Teixeira
AU  - Emilie Uldry
AU  - Ismail Labgaa
PY  - 2026
DA  - 2026/07/30
JO  - Langenbeck's Archives of Surgery
DO  - 10.1007/s00423-026-04054-x
UR  - https://doi.org/10.1007/s00423-026-04054-x
AB  - Purpose: Prediction of major complications (mPOC) after major digestive surgery (MDS) remains challenging. Perioperative gain of weight (ΔWeight) was identified as a promising marker of morbidity after specific types of surgery. This study aimed to assess the predictive value of ΔWeight for mPOC after MDS.  Methods: Retrospective analysis of consecutive patients undergoing MDS between 2013 and 2022. MDS was defined as elective surgery with anticipated duration of ≥ 120 min. Test variable was postoperative weight change calculated on postoperative day 2, defined as ΔWeight. Complications were graded according to Clavien classification. Primary outcome was mPOC (grades > II). Secondary outcomes were overall complications, Comprehensive Complication Index (CCI) and specific subtypes of complications.  Results: A total of 1402 patients were included. MPOC were reported in 392 (27.9%). Median ΔWeight was 2.0 kg [0.4–3.8]. Area under the curve (AUC) of ΔWeight for mPOC was 0.614 (p < 0.001) and maximal Youden index determined a cut-off of 2.6 kg, yielding a negative predictive value of 79%. Patients with ΔWeight above this cut-off showed higher rates of mPOC (38.2 vs. 20.7%, p < 0.001), overall complications (76.2 vs. 47.2%, p < 0.001), anastomotic leak (9.2 vs. 5.0%, p = 0.002), and higher CCI (33.7 vs. 29.6, p < 0.001). Multivariable analysis identified ΔWeight ≥ 2.6 kg as an independent predictor of mPOC (OR, 1.49; 95% CI, 1.03–2.16; p = 0.033).  Conclusion: ΔWeight emerged as a risk-stratification marker across complication types and an independent predictor of major postoperative complications after MDS. This supports perioperative weight monitoring, proactive mitigation of postoperative weight gain, and future studies developing multiparametric prediction tools.  Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00423-026-04054-x.
SN  - 1435-2443
SN  - 1435-2451
ER  -