Body Mass Index as a Predictive Value for Complications Associated With Reconstructive Surgery in Patients With Myelodysplasia

Donovan, Ben; Boci, Mirian; Kropp, Bradley P.; Bright, Brianna C.; Roth, Christopher G.; Confer, Stephen D.; Frimberger, Dominic

doi:10.1016/j.juro.2009.01.052

Cited by 14 publications

(10 citation statements)

References 14 publications

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“…Donovon et al . analyzed a single-institution database of patients with myelodysplasia undergoing reconstruction [9]. They reported unadjusted complication rates of 40% in both the referent group (BMI <85th percentile) and in overweight patients (85th-95th percentile), but found complication rates of 75% in those with a BMI >95th percentile.…”

Section: Discussionmentioning

confidence: 99%

Association of BMI and pediatric urologic postoperative events: Results from pediatric NSQIP

Kurtz

McNamara

Schaeffer

et al. 2015

Journal of Pediatric Urology

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Summary Background Elevated body mass index (BMI) is a well-known risk factor for perioperative complications in adults, but has not been investigated in children undergoing urologic procedures. Given the low rate of complications associated with urologic surgery, a large sample is required for their characterization, but BMI is frequently not available in administrative databases. Here we report results from the first nationally based, prospectively assembled cohort analyzed with respect to the association of BMI with 30-day postoperative events for pediatric urologic procedures. Objective To determine the association of elevated BMI with overall 30-day postoperative events and wound complications in a large national sample of children undergoing urologic procedures. Study design We queried the 2012 Pediatric National Surgical Quality Improvement Program database (NSQIP), defining obesity as a BMI above the 95th percentile and overweight above the 85th percentile, per CDC definitions. We used BMI <85th percentile as a referent group. Complications were collected within 30 days of the procedure. Comorbidity was classified on a linear scale using a validated pediatric-specific comorbidity score, and procedures were classified as genital, abdominal without bowel involvement, or abdominal with bowel involvement. Univariate and multivariate logistic models were used to test significance of associations. Results 2,871 patients aged 2–18 years were analyzed. Of these, 420 (14.6%) were overweight and 440 (15.3%) were obese. A summary of 30-day events and complications is shown in the structured abstract table. On multivariate analysis adjusting for age, gender, class of procedure, and comorbidity, BMI remained a significant risk factor for 30-day events when comparing BMI≥85th percentile to BMI <85th percentile (OR 1.36, 95% CI 1.03–1.8, p=0.035). An exploratory subgroup analysis examining the rate of wound complications demonstrated an odds ratio of 2.36 (95% CI 1.28–4.35, p=0.006) for BMI>85th percentile on multivariate analysis. Discussion Overweight/obese status increased the odds of overall complications by 36%, and of wound complications by 140%. In adults there is a known profound effect of body composition on wound complications, but in children this association is less clear, and has not been studied in the pediatric urologic literature on a large scale. The mechanisms linking BMI to pediatric postoperative complications are unclear, but cytokine mechanisms or changes in the response to inflammation have been postulated. Limitations of this study include restriction to those urologic procedures included in ACS-NSQIPP and sorted into broad general categories. We did not control for secondary procedures. BMI/BMI percentile may not be appropriate measures of body composition in patients with atypical body habitus or proportions (e.g. myelomeningocele). Conclusion BMI in the pediatric NSQIP urologic population was found to be associated with overall complication after adjustment for case type and preope...

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Section: Discussionmentioning

confidence: 99%

Association of BMI and pediatric urologic postoperative events: Results from pediatric NSQIP

Kurtz

McNamara

Schaeffer

et al. 2015

Journal of Pediatric Urology

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“…At adolescence, these children are continent, more independent, and enjoy a better quality of life ( 21 ) . Donovan et al studied 60 patients with a mean age at enterocystoplasty of 14 years (range: 6 to 29 years; an age range broader than that of our study) and found complications in 52% ( 13 ) . The children in Kurzrock's study who underwent this procedure did so primarily at preschool and school ages ( 21 ) .…”

Section: Discussionmentioning

confidence: 42%

“…This research was conducted to fill a gap in knowledge of the nutritional status of children with NB due to MMC ( 3 , 13 , 19 , 20 ) . The study compared the nutritional status of children with NB due to MMC who did or did not have bladder augmentation surgery.…”

Section: Discussionmentioning

confidence: 99%

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Anthropometric measurements as an indicator of nutritional status in spina bifida patients undergoing enterocystoplasty

Ponte

Rondon

Bacelar

et al. 2013

Einstein (São Paulo)

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Objective:To use anthropometric measurements to compare nutritional status in children with neurogenic bladder dysfunction secondary to meningomyelocele who underwent enterocystoplasty and those who did not undergo surgery.Methods:A case-control study was conducted in 20 children, divided into two groups: those who had enterocystoplasty (Group A) and those who did not undergo surgery (Group B), matched for genre and age. Weight, height, arm circumference, and triceps skinfold thickness were the parameters used. Nutritional assessment was determined by calculating the indexes, based on age and genre. Classification was based on the percentile and the results were compared with the reference values.Results:The mean age was 6.41 years in Group A and 6.35 years in Group B. The interval between surgery and evaluation was 11 months. The following measures were found for Group A: 80% of children were eutrophic, a percentage 30% greater than that in Group B; arm muscle circumference was adequate in 40% of patients, a percentage 20% greater than that in Group B; arm muscle area was adequate in 90%, a percentage 30% greater than that in Group B. Values in Group B were as follows: for triceps skinfold thickness, 60% of patients had values above the mean, a percentage 20% greater than that in Group A; for arm fat index, 60% of patients were above the mean value, 40% greater than in Group A.Conclusion:Patients who had undergone enterocystoplasty showed better nutritional status, while the control group presented higher fat indexes in anthropometric measures. However, the differences between groups were not statistically significant.

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“…20 However, studies of obese patients with stomas due to bladder cancer, neurogenic bladder, or myelodysplasia demonstrate that they are more likely to develop complications, such as parastomal hernia, stomal retraction, and stomal stenosis. [21][22][23] Our results did not show any effect of obesity on the outcomes of CCIC; this may be due to one of the technical advantages of CCIC, in which the bowel segment has a relatively parallel mesenteric blood supply to the terminal ileum, allowing for the creation of a lengthy straight catheterizable channel even in obese patients.…”

mentioning

confidence: 58%

Contemporary multicenter outcomes of continent cutaneous ileocecocystoplasty in the adult population over a 10‐year period: A Neurogenic Bladder Research Group study

Cheng

Keihani

Roth

et al. 2020

Neurourology and Urodynamics

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Aims Evidence is sparse on the long‐term outcomes of continent cutaneous ileocecocystoplasty (CCIC). We hypothesized that obesity, laparoscopic/robotic approach, and concomitant surgeries would affect morbidity after CCIC and aimed to evaluate the outcomes of CCIC in adults in a multicenter contemporary study. Methods We retrospectively reviewed the charts of adult patients from sites in the Neurogenic Bladder Research Group undergoing CCIC (2007‐2017) who had at least 6 months of follow‐up. We evaluated patient demographics, surgical details, 90‐day complications, and follow‐up surgeries. the Mann‐Whitney U test was used to compare continuous variables and χ² and Fisher's Exact tests were used to compare categorical variables. Results We included 114 patients with a median age of 41 years. The median postoperative length of stay was 8 days. At 3 months postoperatively, major complications occurred in 18 (15.8%), and 24 patients (21.1%) were readmitted. During a median follow‐up of 40 months, 48 patients (42.1%) underwent 80 additional related surgeries. Twenty‐three patients (20.2%) underwent at least one channel revision, most often due to obstruction (15, 13.2%) or incontinence (4, 3.5%). Of the channel revisions, 10 (8.8%) were major and 14 (12.3%) were minor. Eleven patients (9.6%) abandoned the catheterizable channel during the follow‐up period. Obesity and laparoscopic/robotic surgical approach did not affect outcomes, though concomitant surgery was associated with a higher rate of follow‐up surgeries. Conclusions In this contemporary multicenter series evaluating CCIC, we found that the short‐term major complication rate was low, but many patients require follow‐up surgeries, mostly related to the catheterizable channel.

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Body Mass Index as a Predictive Value for Complications Associated With Reconstructive Surgery in Patients With Myelodysplasia

Abstract: Patients with myelodysplasia have a high incidence of obesity. Since obesity is associated with a higher complication rate, weight loss programs are highly recommended for obese patients with myelodysplasia before and after any reconstructive surgery.

Cited by 14 publications

References 14 publications

Association of BMI and pediatric urologic postoperative events: Results from pediatric NSQIP

Association of BMI and pediatric urologic postoperative events: Results from pediatric NSQIP

Anthropometric measurements as an indicator of nutritional status in spina bifida patients undergoing enterocystoplasty

Contemporary multicenter outcomes of continent cutaneous ileocecocystoplasty in the adult population over a 10‐year period: A Neurogenic Bladder Research Group study

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