The association between patient body mass index and perioperative outcomes following radical cystectomy: An analysis using the American College of Surgeons National Surgical Quality Improvement Program database

摘要

Introduction 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. Methods 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: 30 kg/m 2 . Our primary outcome was major perioperative complication comprising mortality, reoperation, cardiac event, or neurological event. Results BMI was significantly associated with rates of major complications (p=0.003): major complications were experienced by 17.0% of patients with BMI 30 kg/m 2 . Following multivariable adjustment for relevant demographic, comorbidity, and treatment factors, compared to patients with BMI 18.5–25 kg/m 2 , patients with BMI 30 kg/m 2 (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 (p0.001), bleeding requiring transfusion (p=0.01), and length of stay (p=0.001). Conclusions Patients who are outside of a normal BMI range are more likely to experience major complications following radical cystectomy for bladder cancer.