Obesity and its implications on nononcological urological surgery

Early Postoperative Morbidity of Robotic Versus Open Radical Cystectomy in Obese Patients

Aims: To compare the 30-day postoperative complications of robotic radical cystectomy (RRC) vs open radical cystectomy (ORC) in obese patients (body mass index ≥30) with bladder cancer (BC). Methods: The National Surgical Quality Improvement Program database was queried to identify obese BC patients who underwent RRC or ORC between 2005 and 2016. Patient demographics, postoperative mortality rate, morbidity, operating time (OPTIME), length of stay (LOS), readmission, and reoperation rates were recorded and compared between the two groups. Each RRC patient was matched with three ORC patients using a propensity score approach. Results: Four hundred forty-two RRC patients were matched with 1326 ORC patients. No difference in early postoperative mortality rate between RRC and ORC (0.7% vs 1.3%, relative risk, RR [95% confidence interval CI]: 0.27 [0.07-1.02]). Compared with ORC, the RRC group showed shorter mean OPTIME (364.7 [standard deviation, 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). Compared with ORC, the RR of developing the following events in RRC group was lower: 30-day postoperative any complication (45%), any wound occurrence (64%), blood transfusion (70%), superficial surgical-site infection (78%), and wound disruption (77%). There was no difference in the RR of any-cause readmission (RR [95% CI]: 0.77 [0.57-1.05]) and reoperation (RR [95% CI]: 0.48 [0.22-1.04]) between the two groups. Conclusions: The study revealed that RRC for obese BC patients is associated with shorter OPTIME, shorter LOS, and lower risk of early postoperative complications when compared with a matched group of patients who received ORC. In addition, no difference in early postoperative mortality rate between RRC and ORC was observed.