Obesity Tied to Worse Perioperative Outcomes of Radical Prostatectomy

By Reuters Staff

August 10, 2019

NEW YORK (Reuters Health) - Obese men face higher odds of perioperative complications from radical prostatectomy, according to findings from a database study.

Dr. Sophie Knipper of University Hospital Hamburg-Eppendorf, in Hamburg, Germany, and colleagues used data from the U.S. National Inpatient Sample database from 2008 to 2015 to investigate the effect of obesity (defined as a body mass index of 30 kg/m2 or higher) on perioperative outcomes and total hospital charges associated with robot-assisted (RARP) or open radical prostatectomy (ORP).

Based on data from more than 53,000 men who underwent RARP (8.6% of them obese) and more than 35,000 who underwent ORP (6.9% of them obese), the overall complication rates were 13.1% versus 7.9% of obese versus nonobese RARP patients and 17.4% versus 11.3%, respectively, of ORP patients.

In multivariable analyses, obesity independently predicted 70% higher odds of overall complications, 70% higher odds of miscellaneous medical complications, 80% higher odds of cardiac complications, 60% higher odds of respiratory complications and 70% higher odds of genitourinary complications after RARP.

For ORP, the odds of complications were 50% higher for overall complications in obese patients, 40% higher for miscellaneous medical complications, 80% higher for cardiac complications, 50% higher for respiratory complications, 80% higher for genitourinary complications, 30% higher for blood transfusions, 2.8-fold higher for wound complications, 2.4-fold higher for infectious complications, and 70% higher for vascular complications.

Obesity was not an independent predictor of in-hospital mortality at either RARP or ORP, the researchers report in Urology, online July 20. But obesity was associated with $741 higher total hospital charges for RARP and $312 higher charges for ORP.

Obesity also independently increased the odds of having a length of stay of three or more days by 30% after both RARP and ORP.

"Obesity at RARP translates into fewer adverse perioperative outcomes compared to obesity at ORP," the researchers note. "However, total hospital charges associated with RARP appear to be higher than those associated with ORP in obese patients. Thus, the resulting trade-off between higher cost but more favorable complication profile of RARP in obese patients suggests primarily considering RARP in these patients."

Dr. Knipper did not respond to a request for comments.

SOURCE: https://bit.ly/2LTOZk8

Urology 2019.