The role of obesity in postoperative outcomes of robot-assisted radical cystectomy for bladder cancer.

Abstract

e16611 Background: Bladder cancer (BC) accounts for 6% of all malignancies in the United States and primarily affects older adults. Obesity has been identified as an essential risk factor due to its role in pathophysiology, such as altered sex hormone metabolism, microenvironmental imbalances, and dysregulated insulin and insulin-like growth factor levels. Minimally invasive surgical approaches like robot-assisted radical cystectomy (RARC) have shown improved outcomes, yet data on the impact of obesity on RARC remains scarce. We conducted a retrospective study to evaluate obesity’s effect on short-term outcomes following RARC for BC. Methods: This analysis queried BC patients who underwent RARC between 2016-2022 in the United States via the National Inpatient Sample. The short-term complications were compared between obese and non-obese cases via multivariable regression analyses. Results: Among 15,145 RARC cases, 17.9% involved patients with obsesity. Patients with obesity were younger (67.04 vs. 69.50 years, p < 0.01) but had higher Charlson Comorbidity Index (CCI) scores (3.49 vs. 3.20, p < 0.01) when compared with non-obese individuals. Sex distribution (78.2% male in both groups, p = 0.999) and smoking prevalence (58.0% in obese vs. 56.6% in non-obese, p = 0.190) were comparable. Medicare was the most common insurance coverage (56.5% of obese vs. 64.9% of non-obese), followed by private insurance (35.0% vs. 27.6%, p < 0.01). Obese patients had higher odds of acute kidney injury (AKI) (aOR 1.263, 95% CI 1.142–1.398, p < 0.01), postprocedural respiratory failure (PPRF) (aOR 3.791, 95% CI 2.486–5.781, p < 0.01), and the need for mechanical ventilation (MV) (aOR 1.392, 95% CI 1.073–1.805, p = 0.013). Bleeding odds were insignificant (aOR 1.053, 95% CI 0.965–1.150, p = 0.245), and obese patients had lower odds of sepsis (aOR 0.717, 95% CI 0.536–0.958, p = 0.025). Conclusions: Patients with obesity undergoing RARC for BC face higher risks of complications, including PPRF, MV requirement, and AKI, though they exhibit lower odds of sepsis. These findings emphasize the need for preoperative risk stratification to identify high-risk patients. Multidisciplinary interventions, such as early mobilization, respiratory therapy, and nephroprotective strategies, can help improve outcomes in this patient group.