BMI Impact on Readmissions for Patients Undergoing Robot-Assisted Radical Prostatectomy: A Monocentric, Single-Surgeon Serial Analysis of 500 Cases
Abstract
:1. Introduction
2. Methods
2.1. Surgical Procedure and Setting
2.2. Participants and Methods
2.3. Ethics Statement
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
ADT | Androgen deprivation therapy |
ASA | American Association of Anesthesiology comorbidity score |
AUR | Acute urinary retention |
BMI | Body mass index |
CD | Clavien–Dindo classification of postoperative complications |
Hgb | Hemoglobin |
IIEF | International Index of Erectile Function |
IPSS | International Prostate Symptom Score |
NHT | Neoadjuvant hormonal therapy |
NSTEMI | Non-ST-segment elevation myocardial infarction |
NOBMI | BMI under 30 |
OBMI | BMI equal to/more than 30 |
POD | Postoperative day |
PSA | Prostate-specific antigen |
PSM | Positive surgical margin |
TUR-P | Transurethral resection of the prostate |
RARP | Robot-assisted radical prostatectomy |
SPC | Suprapubic catheter |
TUC | Transurethral catheter |
LOS | Length of hospital stay |
UTI | Urinary tract infection |
VTE | Venous thromboembolism |
UUTO | Upper urinary tract obstruction |
VUA | Vesicourethral anastomosis |
VUAL | Vesicourethral anastomosis leakage |
SVUA | Secondary vesicourethral anastomosis leakage |
References
- Wiltz, A.L.; Shikanov, S.; Eggener, S.E.; Katz, M.H.; Thong, A.E.; Steinberg, G.D.; Shalhav, A.L.; Zagaja, G.P.; Zorn, K.C. Robotic radical prostatectomy in overweight and obese patients: Oncological and validated-functional outcomes. Urology 2009, 73, 316–322. [Google Scholar] [CrossRef]
- Goßler, C.; May, M.; Rosenhammer, B.; Breyer, J.; Stojanoski, G.; Weikert, S.; Lenart, S.; Ponholzer, A.; Dreissig, C.; Burger, M.; et al. Obesity leads to a higher rate of positive surgical margins in the context of robot-assisted radical prostatectomy. Results of a prospective multicenter study. Cent. Eur. J. Urol. 2020, 73, 457–465. [Google Scholar]
- Murakami, T.; Otsubo, S.; Namitome, R.; Shiota, M.; Inokuchi, J.; Takeuchi, A.; Kashiwagi, E.; Tatsugami, K.; Eto, M. Clinical factors affecting perioperative outcomes in robot-assisted radical prostatectomy. Mol. Clin. Oncol. 2018, 9, 575–581. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Wilson, R.L.; Shannon, T.; Calton, E.; Galvão, D.A.; Taaffe, D.R.; Hart, N.H.; Lyons-Wall, P.; Newton, R.U. Efficacy of a weight loss program prior to robot assisted radical prostatectomy in overweight and obese men with prostate cancer. Surg. Oncol. 2020, 35, 182–188. [Google Scholar] [CrossRef] [PubMed]
- Goßler, C.; May, M.; Breyer, J.; Stojanoski, G.; Weikert, S.; Lenart, S.; Ponholzer, A.; Dreissig, C.; Burger, M.; Gilfrich, C.; et al. Aggressive Tumours and Long Console Time Are Independent Predictive Factors for Symptomatic Lymphocele Formation after Robot-Assisted Radical Prostatectomy and Pelvic Lymph Node Dissection. Urol. Int. 2021, 105, 453–459. [Google Scholar] [CrossRef]
- Wenzel, M.; Preisser, F.; Theissen, L.H.; Humke, C.; Welte, M.N.; Wittler, C.; Kluth, L.A.; Karakiewicz, P.I.; Chun, F.K.H.; Mandel, P.; et al. The Effect of Adverse Patient Characteristics on Perioperative Outcomes in Open and Robot-Assisted Radical Prostatectomy. Front. Surg. 2020, 7, 584897. [Google Scholar] [CrossRef]
- Albisinni, S.; Grosman, J.; Aoun, F.; Quackels, T.; Peltier, A.; Van Velthoven, R.; Roumeguère, T. Exploring positive surgical margins after minimally invasive radical prostatectomy: Does body habitus really make a difference? Prog. Urol. 2018, 28, 434–441. [Google Scholar] [CrossRef] [PubMed]
- Abdul-Muhsin, H.; Giedelman, C.; Samavedi, S.; Schatloff, O.; Coelho, R.; Rocco, B.M.C.; Palmer, K.; Ebra, G.; Patel, V. Perioperative and early oncological outcomes after robot-assisted radical prostatectomy (RARP) in morbidly obese patients: A propensity score-matched study. BJU Int. 2014, 113, 84–91. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- McDougal, W.S.; Wein, A.J.; Kavoussi, L.R.; Partin, A.W.; Peters, C.A. Campbell-Walsh Urology 11th Edition Review E-Book: Elsevier Health Sciences; Elsevier: Amsterdam, The Netherlands, 2015. [Google Scholar]
- Beyer, B.; Kühne, K.; Böhm, K.; Schiffmann, J.; Heinzer, H.; Michl, U.; Huland, H.; Graefen, M.; Haese, A.; Steuber, T. DaVinci robot-assisted laparoscopic prostatectomy: Benefit for obese men? A matched-pair analysis. Urologe A 2015, 54, 34–40. [Google Scholar] [CrossRef]
- Ahlering, T.E.; Eichel, L.; Edwards, R.; Skarecky, D.W. Impact of obesity on clinical outcomes in robotic prostatectomy. Urology 2005, 65, 740–744. [Google Scholar] [CrossRef] [Green Version]
- Sarychev, S.; Witt, J.H.; Wagner, C.; Oelke, M.; Schuette, A.; Liakos, N.; Karagiotis, T.; Mendrek, M.; Kachanov, M.; Graefen, M.; et al. Impact of obesity on perioperative, functional and oncological outcomes after robotic-assisted radical prostatectomy in a high-volume center. World J. Urol. 2022, 40, 1419–1425. [Google Scholar] [CrossRef] [PubMed]
- Xia, L.; Taylor, B.L.; Pulido, J.E.; Mucksavage, P.; Lee, D.I.; Guzzo, T.J. Predischarge Predictors of Readmissions and Postdischarge Complications in Robot-Assisted Radical Prostatectomy. J. Endourol. 2017, 31, 864–871. [Google Scholar] [CrossRef] [PubMed]
- Lantz, A.W.; Stranne, J.; Tyritzis, S.I.; Bock, D.; Wallin, D.; Nilsson, H.; Carlsson, S.; Thorsteinsdottir, T.; Gustafsson, O.; Hugosson, J.; et al. 90-Day readmission after radical prostatectomy-a prospective comparison between robot-assisted and open surgery. Scand. J. Urol. 2019, 53, 26–33. [Google Scholar] [CrossRef] [PubMed]
- Knipper, S.; Mazzone, E.; Mistretta, F.A.; Palumbo, C.; Tian, Z.; Briganti, A.; Saad, F.; Tilki, D.; Graefen, M.; Karakiewicz, P.I. Impact of Obesity on Perioperative Outcomes at Robotic-assisted and Open Radical Prostatectomy: Results From the National Inpatient Sample. Urology 2019, 133, 135–144. [Google Scholar] [CrossRef]
- Mikhail, A.A.; Stockton, B.R.; Orvieto, M.A.; Chien, G.W.; Gong, E.M.; Zorn, K.C.; Brendler, C.B.; Zagaja, G.P.; Shalhav, A.L. Robotic-assisted laparoscopic prostatectomy in overweight and obese patients. Urology 2006, 67, 774–779. [Google Scholar] [CrossRef]
- Xu, T.; Wang, X.; Xia, L.; Zhang, X.; Qin, L.; Zhong, S.; Shen, Z. Robot-assisted prostatectomy in obese patients: How influential is obesity on operative outcomes? J. Endourol. 2015, 29, 198–208. [Google Scholar] [CrossRef]
- Mottet, N.; van den Bergh, R.C.N.; Briers, E.; van den Broeck, T.; Cumberbatch, M.G.; De Santis, M.; Fanti, S.; Fossati, N.; Gandaglia, G.; Gillessen, S.; et al. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur. Urol. 2021, 79, 243–262. [Google Scholar] [CrossRef]
- Gandaglia, G.; Martini, A.; Ploussard, G.; Fossati, N.; Stabile, A.; De Visschere, P.; Borgmann, H.; Heidegger, I.; Steinkohl, F.; Kretschmer, A.; et al. External Validation of the 2019 Briganti Nomogram for the Identification of Prostate Cancer Patients Who Should Be Considered for an Extended Pelvic Lymph Node Dissection. Eur. Urol. 2020, 78, 138–142. [Google Scholar] [CrossRef]
- Eifler, J.B.; Feng, Z.; Lin, B.M.; Partin, M.T.; Humphreys, E.B.; Han, M.; Epstein, J.I.; Walsh, P.C.; Trock, B.J.; Partin, A.W. An updated prostate cancer staging nomogram (Partin tables) based on cases from 2006 to 2011. BJU Int. 2013, 111, 22–29. [Google Scholar] [CrossRef]
- Farzat, M.; Rosenbauer, J.; Tanislav, C.; Wagenlehner, F.M. Prostate Volume Influence on Postoperative Outcomes for Patients Undergoing RARP: A Monocentric Serial Analysis of 500 Cases. J. Clin. Med. 2023, 12, 2491. [Google Scholar] [CrossRef]
- Krausewitz, P.; Farzat, M.; Ellinger, J.; Ritter, M. Omitting routine cystography after RARP: Analysis of complications and readmission rates in suprapubic and transurethral drained patients. Int. J. Urol. 2022, 30, 211–218. [Google Scholar] [CrossRef] [PubMed]
- Farzat, M.; Weib, P.; Sukhanov, I.; Rosenbauer, J.; Tanislav, C.; Wagenlehner, F.M. Effect of Neoadjuvant Hormonal Therapy on the Postoperative Course for Patients Undergoing Robot-Assisted Radical Prostatectomy. J. Clin. Med. 2023, 12, 3053. [Google Scholar] [CrossRef] [PubMed]
Total (500) | NOBMI (n = 336, 67.2%) | OBMI (164, 32.8%) | p-Value | |
---|---|---|---|---|
Age (year) | ||||
Mean ± SD IQR Median | 66.8 ± 7.1 62–72 68 | 66.75 ± 6.6 61.25–72 68 | 66.95 ± 8 62–72 68 | 0.769 |
ASA score | ||||
1 2 3 Missing | 96 (19.2) 314 (62.8) 82 (16.4) 8 (1.6) | 81 (24.1) 219 (65.2) 34 (10.1) 2 (0.6) | 15 (9.1) 95 (57.9) 48 (29.3) 6 (3.6) | >0.001 |
Preoperative HGB (g/dL) | ||||
Mean ± SD IQR Median | 14.7 ± 1.3 14.1–15.5 14.8 | 14.7 ± 1.26 (14.1–15.5) 14.8 | 14.65 ±1.38 (13.9–15.5) 14.8 | 0.491 |
IPSS | ||||
Mean ± SD IQR Median | 11.4 ± 8.3 5–16 8.3 | 11.43 ± 8.2 (5–16) 10 | 11.4 ± 8.4 (4–17.5) 10 | 0.437 |
IIEF | ||||
Mean ± SD IQR Median | 15.2 ± 8.7 6–23 17 | 16.3 ± 8.5 8–24 17 | 13.1 ± 8.5 8–24 12 | 0.001 |
Initial PSA (ng/mL) | ||||
Mean ± SD IQR Median | 14.8 ± 24.5 5.5–13.6 8 | 14.4 ± 23.8 5.4–12.6 7.7 | 15.6 ± 26 5.6–14.9 9 | 0.607 |
Prostate Volume (mL) | ||||
Mean ± SD IQR Median | 49 ± 28 31–60 43 | 46 ± 23.1 31–56 41 | 55 ± 37 31–56 47 | 0.002 |
Pretreatment | ||||
Medical Surgical | 55 (11) 34 (6.8) | 29 (8.6) 22 (6.5) | 26 (15.8) 12 (7.3) | 0.050 0.856 |
D’Amico Risk Classification | ||||
Low Risk Intermediate Risk High Risk | 117 (23.4) 229 (45.8) 154 (30.8) | 90 (26.8) 145 (43.2) 101 (30.1) | 27 (16.5) 84 (51.2) 53 (32.3) | 0.083 |
Preoperative Gleason Score | ||||
5 6 3 + 4 4 + 3 8 9 10 Unclassified * | 1 (0.2) 140 (28) 176 (35.2) 59 (11.8) 82 (16.4) 36 (7.2) 5 (1.0) 1 (0.2) | 1 (0.3) 105 (31.3) 112 (33.3) 38 (11.3) 54 (16.1) 22 (6.5) 3 (0.9) 1 (0.3) | 35 (21.3) 64 (39) 21 (12.8) 28 (17.1) 14 (8.5) 2 (1.2) | 0.327 |
Nerve Sparing | ||||
Yes Partial No | 374 (69.4) 19 (3.8) 134 (26.8) | 247 (73.5) 13 (3.9) 76 (22.6) | 100 (61) 6 (3.7) 58 (35.4) | 0.005 |
Total (500) | NOBMI (n = 336, 67.2%) | OBMI (164, 32.8%) | p-Value | |
---|---|---|---|---|
Console Time (Minute) Mean ± SD IQR Median | 151 ± 45 120–180 140 | 150 ± 47 120–178 140 | 152 ± 41 120–178 140 | 0.760 |
Prostate Weight (g) Mean ± SD IQR Median | 61 ± 25.6 64–72 55 | 58 ± 22.9 43.7–69 52 | 68 ± 29 50–80.5 62 | 0.009 |
Pathological Stage 0 pT1 pT2 pT3 pT4 | 1 (0.2) 1 (0.2) 295 (59) 183 (36.6) 20 (4.0) | 212 (63) 112 (33.3) 12 (3.6) | 1 (0.6) 1 (0.6) 83 (50.6) 71 (43.2) 8 (4.8) | 0.088 |
Postoperative Gleason Score 6 3 + 4 4 + 3 8 9 10 Unclassified * | 28 (5.6) 282 (56.4) 89 (17.8) 26 (5.2) 29 (5.8) 1 (0.2) 45 (9.0) | 22 (6.5) 195 (58) 59 (17.6) 18 (5.4) 16 (4.8) 1 (0.3) 25 | 6 (3.7) 87 (53) 30 (18.3) 8 (4.9) 13 (7.9) 20 | 0.284 |
Positive Surgical Margins (Total) <3 mm >3 mm | 36 (7.2) 17 (3.4) 19 (3.8) | 19 (5.7) 10 (2.9) 9 (2.6) | 17 (10.4) 7 (4.2) 10 (6.1) | 0.056 |
Number of Lymph Nodes Mean ± SD IQR Median | 19.6 ± 7.4 (15–24) 18 | 19 ± 7 14–23 18 | 20.9 ± 8 16–26.7 19 | 0.008 |
Positive Lymph Nodes | 87 (17.4) | 54 (16.1) | 33 (20.1) | 0.262 |
HGB Difference (g/dL) Mean ± SD IQR Median | 2.5 ± 4.8 1.9–3.5 2.6 | 2.7 ± 1.3 2.0–3.6 2.7 | 1.9 ± 8.1 1.7–3.4 2.5 | 0.082 |
Transfusion | 7 (1.2) | 5 (1.4) | 2 (1.2) | 0.162 |
Hospitalization (days) Mean ± SD IQR Median | 5.6 ± 1.5 5–6 5 | 5.5 ± 1.2 5–6 5 | 5.7 ± 2.1 5–6 5 | 0.438 |
Catheter Days Mean ± SD IQR Median | 6.9 ± 4.7 4–10 5 | 6.89 ± 4.7 4–10 5 | 7.03 ± 4.6 4–10 5 | 0.092 |
Total (n = 500) | NOBMI (n = 336, 67.2%) | OBMI (164, 32.8%) | p-Value | |||
---|---|---|---|---|---|---|
Minor | CDI 51 (10.2) | Thrombus/Embolism | 4 (0.8) | 2 (0.6) | 2 (1.2) | 0.464 |
Elevated Labor Parameter | 6 (1.2) | 1 (0.3) | 5 (3.0) | |||
AUR | 18 (3.6) | 10 (2.9) | 8 (5.7) | |||
Diverse | 13 (2.6) | 7 (2.0) | 6 (3.6) | |||
CD II 23 (4.6) | Secondary VUAL * | 11 (2.2) | 8 (2.3) | 3 (1.8) | ||
UTIs | 11 (2.2) | 8 (2.3) | 3 (1.8) | |||
Hematoma Requiring Transfusion | 1 (0.2) | 1 (0.3) | 0 | |||
Major | CD III a 12 (2.4) | Myocardial Infarction | 1 (0.2) | 1 (0.3) | 0 | 0.316 |
Hiatus Hernia | 1 (0.2) | 1 (0.3) | 0 | |||
Symptomatic Lymphocele | 10 (2.0) | 5 (1.4) | 5 (3.0) | |||
CD III b 8 (1.6) | Revision | 5 (1.0) | 3 (0.9) | 2 (1.2) | ||
UUTO | 3 (0.6) | 2 (0.6) | 1 (0.6) | |||
CD IV 1 (0.2) | Rhabdomyolysis | 1 (0.2) | 1 (0.3) | 0 | ||
Readmissions | 28 (5.6) | 21 (6.25) | 7 (4.2) | 0.336 |
Readmission | Major Complications | Catheter Days | Hospital Stay | Lymphoceles | Positive Surgical Margins | Transfusion | |
---|---|---|---|---|---|---|---|
BMI | 0.221 | 0.200 | 0.225 | 0.317 | 0.673 | 0.021 | 0.234 |
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Farzat, M.; Sharabaty, I.; Tanislav, C.; Alsaid, Y.; Wagenlehner, F.M. BMI Impact on Readmissions for Patients Undergoing Robot-Assisted Radical Prostatectomy: A Monocentric, Single-Surgeon Serial Analysis of 500 Cases. J. Clin. Med. 2023, 12, 3908. https://doi.org/10.3390/jcm12123908
Farzat M, Sharabaty I, Tanislav C, Alsaid Y, Wagenlehner FM. BMI Impact on Readmissions for Patients Undergoing Robot-Assisted Radical Prostatectomy: A Monocentric, Single-Surgeon Serial Analysis of 500 Cases. Journal of Clinical Medicine. 2023; 12(12):3908. https://doi.org/10.3390/jcm12123908
Chicago/Turabian StyleFarzat, Mahmoud, Ismail Sharabaty, Christian Tanislav, Yaman Alsaid, and Florian M. Wagenlehner. 2023. "BMI Impact on Readmissions for Patients Undergoing Robot-Assisted Radical Prostatectomy: A Monocentric, Single-Surgeon Serial Analysis of 500 Cases" Journal of Clinical Medicine 12, no. 12: 3908. https://doi.org/10.3390/jcm12123908