Department of Surgery, Section of Urology, University of Chicago Medicine, Section of Urology, Chicago, IL.
Department of Surgery, Section of Urology, University of Chicago Medicine, Section of Urology, Chicago, IL.
Urol Oncol. 2024 Dec;42(12):450.e23-450.e28. doi: 10.1016/j.urolonc.2024.06.020. Epub 2024 Jul 10.
Radical cystectomy is a highly morbid procedure with short term perioperative complications rates cited to be as high as 60%. Short term perioperative complications have been demonstrated to be more frequent in underweight and overweight patients. We sought to evaluate the impact of metabolic syndrome on surgical outcomes.
We identified 19,071 eligible patients who underwent radical cystectomy for nonmetastatic bladder cancer using the American College of Surgeons National Surgical Quality Improvement Program database between the years 2014 to 2021. The primary exposure was the presence of metabolic syndrome (body mass index >30, hypertension, diabetes) and included 1,566 patients. Our primary outcome was the development of a post operative surgical complication with secondary outcomes of the impact on length of stay, return to operating room, readmission, and 30 day mortality.
Metabolic syndrome was associated with an increased rate of complications following radical cystectomy (P < 0.001). Complications were demonstrated in 68% of patients with metabolic syndrome in comparison to 60% of those without. Following multivariable adjustment for relevant demographic, comorbidity, and treatment factors, compared to patients without metabolic syndrome, patients with metabolic syndrome were significantly more likely to experience a complication in the 30 days following cystectomy. Among the secondary outcomes, on multivariable analysis significant differences were found in the risk of readmission and extended length of stay. Critically, the risk of 30 day morbidity was associated with a 1.8 fold increase in those with metabolic syndrome.
Metabolic syndrome demonstrates significantly worse perioperative outcomes following radical cystectomy for bladder cancer.
根治性膀胱切除术是一种高度病态的手术，其短期围手术期并发症发生率高达 60%。已经证明，超重和肥胖患者的短期围手术期并发症更为频繁。我们试图评估代谢综合征对手术结果的影响。
我们使用美国外科医师学会国家手术质量改进计划数据库，在 2014 年至 2021 年间确定了 19071 名接受非转移性膀胱癌根治性膀胱切除术的合格患者。主要暴露因素是代谢综合征（BMI>30、高血压、糖尿病）的存在，包括 1566 名患者。我们的主要结果是术后手术并发症的发生，次要结果是对住院时间、重返手术室、再入院和 30 天死亡率的影响。
代谢综合征与根治性膀胱切除术后并发症发生率增加相关（P<0.001）。在患有代谢综合征的患者中，并发症发生率为 68%，而在没有代谢综合征的患者中为 60%。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，与没有代谢综合征的患者相比，患有代谢综合征的患者在膀胱切除术后 30 天内发生并发症的风险显著更高。在次要结果中，在多变量分析中，在再入院和延长住院时间方面存在显著差异。重要的是，30 天发病率的风险与代谢综合征患者的发病率增加 1.8 倍相关。
代谢综合征在膀胱癌根治性膀胱切除术后表现出明显更差的围手术期结果。
