Backes Floor J, Rosen Maggie, Liang Margaret, McCann Georgia A, Clements Aine, Cohn David E, OʼMalley David M, Salani Ritu, Fowler Jeffrey M
*Department of Obstetrics and Gynecology, Division of Gynecology Oncology, The Ohio State University College of Medicine, Columbus, OH; and †University of Texas Health Science Center at San Antonio, San Antonio, TX.
Int J Gynecol Cancer. 2015 Sep;25(7):1271-6. doi: 10.1097/IGC.0000000000000480.
The objective of this study is to determine (1) if there is a relationship between increasing body mass index (BMI) and postoperative complications in patients undergoing robotic hysterectomy for endometrial cancer and (2) if there are additional patient characteristics, specifically preoperative comorbidities, which increase the risk of postoperative complication
A retrospective chart review was conducted on women who underwent a robotic staging surgery for endometrial cancer from 2006 to 2012. Basic demographics and preoperative and postoperative complications were extracted from the medical records. Obesity was divided into 4 categories, and complication rates were compared across these subgroups. Patients were also divided by the number of comorbidities and compared.
The cohort included 543 patients. The BMI ranged from 17.3 to 69.5 kg/m. Three hundred eighty patients (70%) were obese (BMI >30 kg.m). One hundred ninety patients (35%) had no comorbidities other than obesity, and 180 patients (33%) had only 1 comorbidity other than obesity (Table 1).Postoperative complications occurred in 102 (18.7%) of the patients. Severe postoperative complications, including intensive care unit admission, reintubation, reoperation, and perioperative death, occurred in 14 patients (2.6%). Of the nonobese patients, 27 (16.5%) had postoperative complications; of the obese patients, 75 (19.7%) had a complication (P = 0.38). In patients with no comorbidities, 16.3% had a complication; 18% of patients with 1 to 2 comorbidities had a complication, and 28% of patients with 3 or more comorbidities had a complication (P = 0.08).
The postoperative complication rate based on BMI or number of comorbidities was not statistically significant, but patients with greater number of comorbidities had an increased rate of postoperative complications. Patients with certain comorbidities, cardiac and renal specifically, had the highest rates of postoperative complications.
本研究的目的是确定：（1）在接受机器人辅助子宫内膜癌子宫切除术的患者中，体重指数（BMI）增加与术后并发症之间是否存在关联；（2）是否存在其他患者特征，特别是术前合并症，会增加术后并发症的风险。
对2006年至2012年接受机器人辅助子宫内膜癌分期手术的女性进行回顾性病历审查。从医疗记录中提取基本人口统计学信息以及术前和术后并发症情况。肥胖分为4类，并比较这些亚组的并发症发生率。患者还按合并症数量进行分组并比较。
该队列包括543例患者。BMI范围为17.3至69.5kg/m²。380例患者（70%）肥胖（BMI>30kg/m²）。190例患者（35%）除肥胖外无其他合并症，180例患者（33%）除肥胖外仅有1种合并症（表1）。102例患者（18.7%）发生术后并发症。14例患者（2.6%）发生严重术后并发症，包括入住重症监护病房、再次插管、再次手术和围手术期死亡。非肥胖患者中，27例（16.5%）发生术后并发症；肥胖患者中，75例（19.7%）发生并发症（P=0.38）。无合并症的患者中，16.3%发生并发症；1至2种合并症的患者中，18%发生并发症，3种或更多合并症的患者中，28%发生并发症（P=0.08）。
基于BMI或合并症数量的术后并发症发生率无统计学意义，但合并症数量较多的患者术后并发症发生率增加。某些合并症患者，特别是心脏和肾脏合并症患者，术后并发症发生率最高。
