TY - JOUR
T1 - The association between patient body mass index and perioperative outcomes following radical cystectomy
T2 - An analysis using the American College of Surgeons National Surgical Quality Improvement Program database
AU - Lenardis, Matthew
AU - Harper, Benjamin
AU - Satkunasivam, Raj
AU - Klaassen, Zachary
AU - Wallis, Christopher
N1 - Publisher Copyright:
© 2020 Canadian Urological Association
PY - 2020/3/30
Y1 - 2020/3/30
N2 - Introduction: Radical cystectomy is a highly morbid procedure with 30-day perioperative complication rates approaching 50%. Our objective was to determine the effect of patients' body mass index (BMI) on perioperative outcomes following radical cystectomy for bladder cancer. Methods: We identified 3930 eligible patients who underwent radical cystectomy for non-metastatic bladder cancer using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. The primary exposure was preoperative BMI, categorically operationalized in four strata according to the World Health Organization criteria: <18.5 kg/m2, 18.5-25 kg/m2, 25-30 kg/m2, and >30 kg/m2. Our primary outcome was major perioperative complication comprising mortality, reoperation, cardiac event, or neurological event. Results: BMI was significantly associated with rates of major complications (p=0.003): major complications were experienced by 17.0% of patients with BMI <18.5 kg/m2, 7.8% of patients with BMI 18.5-25 kg/m2, 7.9% of patients with BMI 25-30 kg/m2, and 10.8% of patient with BMI >30 kg/m2. Following multivariable adjustment for relevant demographic, comorbidity, and treatment factors, compared to patients with BMI 18.5-25 kg/m2, patients with BMI <18.5 kg/m2 (odds ratio [OR] 2.28; 95% confidence interval [CI] 1.07-4.78) and BMI >30 kg/m2 (OR 1.59; 95% CI 1.17-2.16) were significantly more likely to experience a major complication in the 30 days following cystectomy. Among the secondary outcomes, significant differences were identified in rates of pulmonary complications (p=0.003), infectious complications (p<0.001), bleeding requiring transfusion (p=0.01), and length of stay (p=0.001). Conclusions: Patients who are outside of a normal BMI range are more likely to experience major complications following radical cystectomy for bladder cancer.
AB - Introduction: Radical cystectomy is a highly morbid procedure with 30-day perioperative complication rates approaching 50%. Our objective was to determine the effect of patients' body mass index (BMI) on perioperative outcomes following radical cystectomy for bladder cancer. Methods: We identified 3930 eligible patients who underwent radical cystectomy for non-metastatic bladder cancer using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. The primary exposure was preoperative BMI, categorically operationalized in four strata according to the World Health Organization criteria: <18.5 kg/m2, 18.5-25 kg/m2, 25-30 kg/m2, and >30 kg/m2. Our primary outcome was major perioperative complication comprising mortality, reoperation, cardiac event, or neurological event. Results: BMI was significantly associated with rates of major complications (p=0.003): major complications were experienced by 17.0% of patients with BMI <18.5 kg/m2, 7.8% of patients with BMI 18.5-25 kg/m2, 7.9% of patients with BMI 25-30 kg/m2, and 10.8% of patient with BMI >30 kg/m2. Following multivariable adjustment for relevant demographic, comorbidity, and treatment factors, compared to patients with BMI 18.5-25 kg/m2, patients with BMI <18.5 kg/m2 (odds ratio [OR] 2.28; 95% confidence interval [CI] 1.07-4.78) and BMI >30 kg/m2 (OR 1.59; 95% CI 1.17-2.16) were significantly more likely to experience a major complication in the 30 days following cystectomy. Among the secondary outcomes, significant differences were identified in rates of pulmonary complications (p=0.003), infectious complications (p<0.001), bleeding requiring transfusion (p=0.01), and length of stay (p=0.001). Conclusions: Patients who are outside of a normal BMI range are more likely to experience major complications following radical cystectomy for bladder cancer.
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U2 - 10.5489/CUAJ.6243
DO - 10.5489/CUAJ.6243
M3 - Article
AN - SCOPUS:85085686162
SN - 1911-6470
VL - 14
JO - Journal of the Canadian Urological Association
JF - Journal of the Canadian Urological Association
IS - 9
ER -