Rethinking Risk in Glossectomy: Obesity and Overweight Status Linked to Fewer Complications and Shorter Hospital Stays.

BACKGROUND

The obesity paradox suggests higher body mass index (BMI) may improve surgical outcomes despite being a traditional risk factor. This phenomenon has not been evaluated in glossectomy.

METHODS

A retrospective cohort study of 6816 patients undergoing partial or total glossectomy (ACS-NSQIP, 2006-2022) was performed. Patients were stratified by BMI. Outcomes included operative time, length of stay (LOS), 30-day readmission, and complications. Univariate and multivariable analyzes were conducted.

RESULTS

Obese patients (30.8%) had the shortest LOS (1 day) and lowest complication rate (11.7%) (p < 0.001). Underweight patients (4.0%) had the longest operative time (393 min), LOS (8 days), and highest complication rate (35.9%) (p < 0.001). After adjusting for procedural complexity and covariates, overweight/obese BMI remained independently associated with shorter LOS and lower odds of complications, whereas underweight BMI independently predicted worse outcomes.

CONCLUSIONS

Findings support an obesity paradox in glossectomy, driven primarily by the vulnerability of underweight patients rather than a protective effect of adiposity.