Presentation Authors: Brian T. Langford*, Mohamed H. Kamel, Mahmoud I. Khalil, Naleen Raj Bhandari, Nalin Payakachat, Little Rock, AR, Omer A. Raheem, New Orleans, LA, Rodney Davis, Little Rock, AR
Introduction: The obese (BMI â‰¥ 30) population often have multiple comorbidities. Radical cystectomy with urinary diversion is a major procedure in the obese. In this study we compared the 30-day postoperative complications of robotic assisted radical cystectomy (RARC) versus open radical cystectomy (ORC) in obese patients with bladder cancer (BC). We utilized the National Surgical Quality Improvement Program (NSQIP) database of the American College of Surgeons.
Methods: NSQIP was queried to identify all obese BC patients who underwent either RARC or ORC between 2005- 2016. Patient demographics, medical comorbidities, American Society of Anesthesiologists (ASA) classification, operative time (OPTIME), length of stay (LOS) and 30-day postoperative complications were recorded. Each RARC patient as matched with 3 ORC patients using a propensity score (PS) approach. Relative risk (RR [95%CI]) of 30-day post-operative complications in RARC vs. ORC patients was calculated and adjusted for matched design.
Results: 442 RARC patients were matched with 1326 ORC patients. In both groups, the most common age group was 65-74 years (37%) and most were males (75-78%), white (84%), current nonsmokers (82%) and ASA class III (64-65%). Hypertension (65-66%) and diabetes (25-27%) were the most prevalent comorbidities in both groups. Compared to ORC, RARC group showed shorter mean OPTIME (364.7 (SD=133.4) vs 387.8 (SD=129.7) minutes, p=0.001) and mean LOS (7.1 (SD=5.6) vs 10.6 (SD= 6.6) days, p < 0.001). The incidences of the most common complications among the two groups are illustrated in table 1. Compared to ORC, the relative risk of developing these complications in RARC group was lower (table 1): 30-day postoperative any complication (49%), any readmission (29%), blood transfusion (71%), sepsis (34%), return to operating room (49%), wound disruption (73%), organ space infection (pelvic collection), Superficial and deep wound infection ( 44%, 79% and 74% respectively).
Conclusions: RARC for obese BC patients is associated with shorter OPTIME, shorter LOS and lower risk of early postoperative complications compared to ORC.