(UroToday.com) It is known that obesity is extremely common in the United States and affects approximately 60 million people. This number is expected to rise to an alarming 50% of the population in 2030 (Figure 1). High body-mass index (BMI) can affect quality metrics like readmission to hospitals.
In this presented study, the authors used the national surgical quality improvement program database (NSQIP) to determine the relationship of BMI to readmission rates after minimally invasive radical prostatectomy.
Figure 1: 
According to the Center for Disease Control (CDC), obesity is defined in a three-tiered manner based on BMI :
- Class 1 - between 30 to 34.9
- Class 2 - between 34 in 39.9
- Class 3 - above 40
All data regarding surgeries performed between 2007 and 2017 was analyzed from the NSQIP database. A total of 49,238 men in this time period underwent minimally invasive radical prostatectomy. The mean BMI for all years ranged from 28.5 to 29.2. More than 37% of patients who underwent surgery had a BMI of above 30. A total of 13,130 patients were defined as having obesity Class 1, 4040 patients had obesity Class 2, and 1180 cases had an obesity class 3.
From 2007 to 2017, the proportion of patients with a BMI of above 30 increased from 32% in 2007 to 38% in 2017. Accordingly, the risk of hospital readmission also increased as BMI increased with an odds ratio of 1.16 for each standard deviation increase in BMI. Increasing severity of BMI corresponded to an increase in the odds ratio for readmission, as can be seen in Table 1.
Table 1:
The authors concluded that during a time period of 10 years, an increasing number of patients underwent minimally invasive radical prostatectomy who had a BMI of over 30. This can directly influence hospital readmission rates. These data show that urologists are increasingly operating on more obese patients and that obesity can negatively impact quality metrics, including affecting the percentage of hospital readmission after surgery. It is crucial that patients are optimized preoperatively and that weight-loss before surgery should be a key goal in these patients.
Presented by: Ethan Matz, MD, Wake Forest School of Medicine, Winston-Salem, NC
Written by: Hanan Goldberg, MD, MSc., Urology Department, SUNY Upstate Medical University, Syracuse, NY, USA, Twitter: @GoldbergHanan, at the 2020 American Urological Association (AUA) Annual Meeting, Virtual Experience #AUA20, June 27-28, 2020.