Lenardis Matthew, Harper Benjamin, Satkunasivam Raj, Klaassen Zachary, Wallis Christopher J D
Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Department of Surgery, Division of Urology, Medical College of Georgia at Augusta University, Augusta, GA, United States.
Can Urol Assoc J. 2020 Sep;14(9):E412-E417. doi: 10.5489/cuaj.6243.
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.
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/m, 18.5-25 kg/m, 25-30 kg/m, and >30 kg/m. Our primary outcome was major perioperative complication comprising mortality, reoperation, cardiac event, or neurological event.
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/m, 7.8% of patients with BMI 18.5-25 kg/m, 7.9% of patients with BMI 25-30 kg/m, and 10.8% of patient with BMI >30 kg/m. Following multivariable adjustment for relevant demographic, comorbidity, and treatment factors, compared to patients with BMI 18.5-25 kg/m, patients with BMI <18.5 kg/m (odds ratio [OR] 2.28, 95% confidence interval [CI] 1.07-4.78) and BMI >30 kg/m (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).
Patients who are outside of a normal BMI range are more likely to experience major complications following radical cystectomy for bladder cancer.
根治性膀胱切除术是一种高风险手术，围手术期30天并发症发生率接近50%。我们的目的是确定患者体重指数（BMI）对膀胱癌根治性膀胱切除术后围手术期结局的影响。
我们使用美国外科医师学会国家外科质量改进计划（NSQIP）数据库，确定了3930例接受非转移性膀胱癌根治性膀胱切除术的合格患者。主要暴露因素是术前BMI，根据世界卫生组织标准分为四个层次：<18.5kg/m²、18.5 - 25kg/m²、25 - 30kg/m²和>30kg/m²。我们的主要结局是围手术期主要并发症，包括死亡、再次手术、心脏事件或神经事件。
BMI与主要并发症发生率显著相关（p = 0.003）：BMI<18.5kg/m²的患者中17.0%发生主要并发症，BMI为18.5 - 25kg/m²的患者中7.8%发生，BMI为25 - 30kg/m²的患者中7.9%发生，BMI>30kg/m²的患者中10.8%发生。在对相关人口统计学、合并症和治疗因素进行多变量调整后，与BMI为18.5 - 25kg/m²的患者相比，BMI<18.5kg/m²的患者（比值比[OR] 2.28，95%置信区间[CI] 1.07 - 4.78）和BMI>30kg/m²的患者（OR 1.59，95%CI 1.17 - 2.16）在膀胱切除术后30天内发生主要并发症的可能性显著更高。在次要结局中，肺部并发症发生率（p = 0.003）、感染性并发症发生率（p<0.001）、需要输血的出血发生率（p = 0.01）和住院时间（p = 0.001）存在显著差异。
BMI不在正常范围内的患者在接受膀胱癌根治性膀胱切除术后更有可能发生主要并发症。
