BMI Impact on Readmissions for Patients Undergoing Robot-Assisted Radical Prostatectomy: A Monocentric, Single-Surgeon Serial Analysis of 500 Cases

Abstract

Due to more difficult intraoperative courses, elevated rates of case abortion and unfavored postoperative outcomes in obese patients, urologists tend to consider other therapeutic modalities than prostate removal in very obese patients. With the surge in robotic surgery in the last two decades, more obese patients have undergone robot-assisted radical prostatectomy (RARP). Objective: This current, monocentric, retrospective serial study investigates primarily the impact of obesity on readmissions and secondarily the major complications of RARP. Methods: Five hundred patients from one referral center who underwent RARP between April 2019 and August 2022 were included in this retrospective study. To investigate the impact of patient BMI on postoperative outcomes, we divided our cohort into two groups with a cut-off of 30 kg/m2 (according to the WHO definition). Demographic and perioperative data were analyzed. Postoperative complications and readmission rates were compared between standard, normal patients (NOBMI—BMI under 30; n = 336, 67.2%) and overweight patients (OBMI—BMI equal to/more than 30; n = 164, 32.8%). Results: OBMI patients had bigger prostates on TRUS, more comorbidities and worse baseline erectile function scores. They also received fewer nerve-sparing procedures than their counterparts (p = 0.005). Analysis showed no statistically significant differences in readmission rates or in minor or major complications (p = 0.336, 0.464 and 0.316, respectively). In a univariate analysis, BMI could predict positive surgical margins (p = 0.021). Conclusion: Performing RARP in obese patients seems to be safe and feasible, without major adverse events or elevated readmission rates. Obese patients should be informed preoperatively about the elevated risk of higher PSMs and technically more difficult nerve-sparing procedures.

Cardiovascular Disease and Chronic Pulmonary Disease Increase the Risk of Short-Term Major Postoperative Complications after Robotic-Assisted Radical Prostatectomy

“…Since there are no common guidelines regarding the interventions for lymphoceles, the institutional standard operating procedures (SOPs), including indication (e.g., pain, concomitant thrombosis, fever, elevated inflammatory parameters) as well as the approach to lymphocele treatment (e.g., percutaneous puncture, drainage, and operative fenestration), may vary significantly between different institutions. As a consequence, the overall major postoperative complications rates after radical prostatectomy are extremely variable between different institutions and ranged from 3% to 13% in previous studies [6,9,11,31,32]. In our series, complications were recorded prospectively in the electronic medical records of each patient, which might have led to a higher short-term major postoperative complication rate than in other comparable studies.…”