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Guide
Radical cystectomy (RC) has a high postoperative complication rate, with studies reporting at least 1 complication
in more than 60% of patients within 3 months of RC.
Studies have shown that obesity is a risk factor for poor prognosis of tumor patients, and foreign researchers have conducted a study to explain the association between body mass index (BMI) grouping and RC perioperative complications, and to determine the BMI threshold
when the risk of complications is significantly reduced.
Yimaitong is organized as follows
.
Previous studies have shown that increased obesity increases perioperative morbidity and postoperative mortality, but there are conflicting reports on obesity subgroups and the risk of complications after RC, and the BMI threshold for a significant reduction in complication risk is unclear
.
Establishing this threshold can help reduce the risk
of obesity-related complications in patients with oncology.
Therefore, the investigators conducted this study to compare the perioperative morbidity rate of patients in different BMI groups and to identify the patient population
most likely to develop obesity-related complications.
The researchers collected data from 14 medical centers covered by the Canadian Bladder Cancer Information System, and a total of 589 patient information was included in the analysis
.
The investigators compared the occurrence of perioperative (≤ 90 days) complications in different BMI subgroups, and used multivariate logistic regression and cubic spline analysis to clarify the association between BMI and the risk of complications, and to determine the BMI threshold
.
The study cohort had a total of 589 patients, of whom 341 were muscle-invasive bladder cancer (MIBC) and 248 were non-muscle-invasive bladder cancer (NMIBC).
The median BMI in the study cohort was 27.
5 kg/m2 (IQR,12.
8, 49.
3), and the number of normal-weight, overweight, and obese patients was 168 (29%), 225 (38%), and 196 (33%)
, respectively.
A total of 233 patients (39.
6%) had perioperative complications, and the number of patients with complications (P=0.
02) in the normal-weight, overweight and obese groups was 51 (30), 97 (43%) and 85 (43%)
, respectively.
The specific complication rates are shown in Table 1
.
Table 1 Postoperative complication rates in different BMI groups
Compared with patients with normal BMI, the odds ratios for any complications in the hyperrecombinant and obese groups were 2.
0 (95% CI 1.
26, 3.
17) and 1.
98 (95% CI 1.
24, 3.
18), respectively.
Detailed data are shown in Table 2
.
Table 2 Multivariate logistic regression analysis of complications in overweight and obesity groups
BMI was found to be independently associated with the development of postoperative complications (OR=1.
04, 95% CI 1.
01, 1.
07), particularly wound infection (OR=1.
11) and deep vein thrombosis (DVT, OR=1.
17).
Fig.
1 Forest plot of the association between BMI (continuous variable) and complications
In addition, the results of the three-spline analysis of BMI and risk of complications showed that when BMI > 34 kg/m2, the predicted risk of cooccurrence began to increase significantly (Figure 2).
Fig.
2 Results of three spline analyses of BMI and risk of complications
Studies have confirmed that patients with a higher BMI than ordinary have an increased risk of complications after RC surgery, and when the BMI > 34kg/m2, the risk of complications is significantly increased
.
The determination of this threshold facilitates patient counseling and intervention to control patient weight, reducing the risk
of potential postoperative complications of RC.
References
McLoughlin LC, Kassouf W, Breau RH, Fairey A, Agnihotram V R, Salimi A, Hyndman E, Drachenberg DE, Izawa J, Shayegan B, Lattouf JB, Lodde M, Rendon R, Siemens DR, Jeldres C, Black PC, Kulkarni GS.
Obesity and Complication Risk From Radical Cystectomy: Identifying a Body Mass Index Threshold.
J Urol.
2022 Oct 11:101097JU0000000000002988.
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