肥胖对机器人辅助和开放性根治性前列腺切除术围手术期结局的影响：来自全国住院患者样本的结果。
Impact of Obesity on Perioperative Outcomes at Robotic-assisted and Open Radical Prostatectomy: Results From the National Inpatient Sample.
机构信息
Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
出版信息
Urology. 2019 Nov;133:135-144. doi: 10.1016/j.urology.2019.05.053. Epub 2019 Jul 20.
OBJECTIVE
To test the effect of obesity (body mass index ≥30 kg/m) on perioperative outcomes and total hospital charges at robot-assisted vs open radical prostatectomy (RARP vs ORP).
METHODS
Within the National Inpatient Sample database (2008-2015), we identified obese vs nonobese RARP and ORP patients. Estimated annual percent changes, multivariable logistic regression and linear regression models were used. All models were adjusted for clustering and weighted.
RESULTS
Of all, 53,626 (60%) underwent RARP vs 35,757 (40%) underwent ORP. At RARP, 8.6% were obese vs 6.9% at ORP. RARP rate increased significantly over time (12.5%-81.5%). Obesity rate increased significantly over time at both, RARP (5.1%-10.5%) and ORP (5.4%-10.7%). In multivariable logistic regression models, obesity predicted 5 of 11 unfavourable perioperative complications at RARP (odds ratio: 1.6-1.8) and 9 of 11 at ORP (odds ratio: 1.3-2.8). In linear regression models, obesity significantly added to total hospital charges at RARP (740$) and ORP (312$).
CONCLUSION
Obesity may predispose to higher rates of adverse outcomes at RP. Its effect varies according to surgical approach.
目的
检验肥胖（体重指数≥30kg/m）对机器人辅助根治性前列腺切除术（RARP）与开放性根治性前列腺切除术（ORP）围手术期结局和总住院费用的影响。
方法
我们在国家住院患者样本数据库（2008-2015 年）中，确定了肥胖的 RARP 和 ORP 患者与非肥胖的 RARP 和 ORP 患者。使用了估计年度百分比变化、多变量逻辑回归和线性回归模型。所有模型均进行聚类和加权调整。
结果
共 53626 例（60%）接受了 RARP，35757 例（40%）接受了 ORP。在 RARP 中，肥胖患者占 8.6%，而 ORP 中肥胖患者占 6.9%。RARP 率随着时间的推移显著增加（12.5%-81.5%）。肥胖率在 RARP（5.1%-10.5%）和 ORP（5.4%-10.7%）中也随着时间的推移显著增加。在多变量逻辑回归模型中，肥胖预测了 RARP 的 11 种不良围手术期并发症中的 5 种（优势比：1.6-1.8）和 ORP 的 11 种（优势比：1.3-2.8）。在线性回归模型中，肥胖显著增加了 RARP（740 美元）和 ORP（312 美元）的总住院费用。
结论
肥胖可能使 RP 患者发生不良结局的风险增加。其影响因手术方式而异。
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