Impact of Obesity on Perioperative Outcomes at Robotic-assisted and Open Radical Prostatectomy: Results From the National Inpatient Sample

Sophie Knipper; Elio Mazzone; Francesco A Mistretta; Carlotta Palumbo; Zhe Tian; Alberto Briganti; Fred Saad; Derya Tilki; Markus Graefen; Pierre I Karakiewicz

doi:10.1016/j.urology.2019.05.053

Impact of Obesity on Perioperative Outcomes at Robotic-assisted and Open Radical Prostatectomy: Results From the National Inpatient Sample

Urology. 2019 Nov:133:135-144. doi: 10.1016/j.urology.2019.05.053. Epub 2019 Jul 20.

Authors

Affiliations

¹ 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. Electronic address: a.knipper@uke.de.
² 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.
³ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, European Institute of Oncology, Milan, Italy.
⁴ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Department of Urology, Spedali Civili Hospital, University of Brescia, Brescia, Italy.
⁵ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
⁶ Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy.
⁷ Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada; Division of Urology, University of Montréal Hospital Center, Montréal, Québec, Canada.
⁸ Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
⁹ Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.

PMID: 31336110
DOI: 10.1016/j.urology.2019.05.053

Abstract

Objective: To test the effect of obesity (body mass index ≥30 kg/m²) 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.

Publication types

Comparative Study

MeSH terms

Aged
Databases, Factual
Hospitalization
Humans
Male
Middle Aged
Obesity / complications*
Postoperative Complications / epidemiology*
Postoperative Complications / etiology*
Prostatectomy / methods*
Retrospective Studies
Robotic Surgical Procedures*
Treatment Outcome
United States