To compare early postoperative morbidity and mortality in obese patients (BMI≥30 kg/m2) who underwent Minimally Invasive (MIPN) vs Open partial nephrectomy (OPN) utilizing the National Surgical Quality Improvement Program (NSQIP) database.
NSQIP database was queried to identify obese patients who underwent either MIPN or OPN between 2008 and 2016. Patient demographics, comorbidities, operative time (OT), length of stay (LOS) and 30-day postoperative complications, readmissions and mortality were recorded and compared between the two groups. Multivariable logistic regression analysis was used to determine the adjusted odds of early postoperative complications in MIPN vs. OPN.
6,041 obese MIPN patients and 3064 obese OPN patients were identified. Mean OT (minutes ± SD) was longer for MIPN vs. OPN (197.2 ± 71.0 vs. 189.6 ± 82.4, p<0.001) while mean LOS (3.8 ± 2.8 vs. 5.8 ± 3.5 days, p<0.001) and 30-day complications (8.5% vs. 19.8%, p<0.001) were lower. No difference in 30-day postoperative mortality between MIPN (0.4%) and OPN (0.5%) was observed (p=0.426). In the adjusted analysis, the odds of any complication within 30 days in MIPN group was 61% lower, blood transfusion was 73% lower, pneumonia was 38% lower, sepsis was 70% lower, acute renal failure was 64% lower, superficial surgical site infection was 40% lower and reoperation was 47% lower, compared to OPN patients.
When compared to OPN in obese patients; the likelihood of 30-day postoperative morbidity was significantly lower in MIPN patients. However, the odds of 30-day mortality was similar between the groups.
Journal of endourology. 2019 Jul 23 [Epub ahead of print]
Mahmoud I Khalil, Joel S Ubeda, Thomas L Soehner, Naleen Raj Bhandari, Nalin Payakachat, Rodney Davis, Omer A Raheem, Mohamed H Kamel
University of Arkansas for Medical Sciences, Urology, Little Rock, Arkansas, United States., University of Arkansas for Medical Sciences, Urology, Little Rock, Arkansas, United States; ., University of Arkansas for Medical Sciences, Urology, Little Rock, Arkansas, United States; ., University of Arkansas for Medical Sciences, Division of Pharmaceutical Evaluation and Policy, Little Rock, Arkansas, United States; ., University of Arkansas for Medical Sciences, Division of Pharmaceutical Evaluation and Policy, Little Rock, Arkansas, United States; ., University of Arkansas for Medical Sciences, Urology, 4301 West Markham, #774, Little Rock, Arkansas, United States, 72205; ., Tulane University, 5783, Urology Department, New Orleans, Louisiana, United States; .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/31333072
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