Early Complications and Mortality following Radical Cystectomy: Associations with Malnutrition and Obesity.
Early Complications and Mortality following Radical Cystectomy: Associations with Malnutrition and Obesity.
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DOI：
10.3233/blc-180173
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发表时间：
2018-10-29
期刊：
影响因子：
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通讯作者：
Psutka SP
中科院分区：
文献类型：
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作者：
Arora K;Hanson KT;Habermann EB;Tollefson MK;Psutka SP
关于肥胖对根治性膀胱切除术（RC）术后预后的影响，以及在接受根治性膀胱切除术的患者中肥胖和营养不良如何相互作用，目前有相互矛盾的数据。评估体重指数（BMI）、术前体重显著下降和低白蛋白血症与RC术后30天并发症和死亡率的关系。回顾美国外科医师学会国家手术质量改进计划数据库，确定了2,055例接受RC（2006- 2012）的患者。建立了单因素和多变量logistic回归模型，以评估低白蛋白血症（<3.5 g/dL）、术前体重减轻bb0 ~ 10%、以BMI为特征的肥胖（I类：30 ~ 34.9，II类：35 ~ 39.9，III类：≥40 kg/m2）与30天并发症和死亡率之间的关系。研究队列的BMI中位数为27.82 kg/m2，其中ⅰ类肥胖占22.4%，ⅱ类肥胖占7.5%，ⅲ类肥胖占4.2%。低白蛋白血症和体重下降分别为16.7%和3.5%。在肥胖患者中，13.4%患有低白蛋白血症。在多变量分析中，I类（OR 1.43, p = 0.01）、II类（OR 1.92, p < 0.001）和III类（OR 2.32, p < 0.001）肥胖和低白蛋白血症（OR 1.47, p = 0.02）与30天并发症独立相关，III类肥胖（OR 2.96, p = 0.02）和低白蛋白血症（OR 2.33, p = 0.03）与30天死亡率独立相关。肥胖和低白蛋白血症的增加与RC术后并发症的增加独立相关。低白蛋白血症和III类肥胖与早期死亡率相关。这项研究强调了营养不良可能在肥胖患者中共存的事实，并强调了确定营养不良患者的必要性，这些患者可能是术前营养优化的候选者。
There are conflicting data regarding the impact of obesity on postoperative outcomes following radical cystectomy (RC) and how obesity and malnutrition interact in patients undergoing RC. To evaluate associations of body mass index (BMI), significant preoperative weight loss, and hypoalbuminemia with 30-day complications and mortality after RC. Review of the American College of Surgeons National Surgical Quality Improvement Program database identified 2,055 patients who underwent RC (2006-12). Univariate and multivariable logistic regression models were developed to assess associations between hypoalbuminemia (<3.5 g/dL), >10% preoperative weight loss, obesity as characterized by BMI (class I: 30–34.9, II: 35–39.9, III: ≥40 kg/m2), and 30-day complications and mortality. The median BMI of the study cohort was 27.82 kg/m2 with 22.4% classified as having class I, 7.5% class II, and 4.2% class III obesity, respectively. Hypoalbuminemia and >10% weight loss were present in 16.7% and 3.5%, respectively. Among obese patients, 13.4% had hypoalbuminemia. On multivariable analysis, class I (OR 1.43, p = 0.01), class II (OR 1.92, p < 0.001), and class III (OR 2.32, p < 0.001) obesity and hypoalbuminemia (OR 1.47, p = 0.02) were independently associated with 30-day complications, and class III obesity (OR 2.96, p = 0.02) and hypoalbuminemia (OR 2.33, p = 0.03) were independently associated with 30-day mortality. Increasing class of obesity and hypoalbuminemia were independently associated with increased complications following RC. Hypoalbuminemia and class III obesity were associated with early mortality. This study highlights the fact that malnutrition may coexist in obese patients and underscores the need to identify patients with malnutrition who may be candidates for preoperative nutritional optimization.