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Effect of BMI on Short-Term Outcomes With Robotic-Assisted Laparoscopic Surgery: a Case-Matched Study
Nisreen Madhoun*1, 2, Deborah Keller1, Jean-Paul J. Lefave1, 2, Madhu Ragupathi1, Juan R. Flores1, Sergio Ibarra1, Eric M. Haas1, 2
1Colorectal Surgical Associates, Houston, TX; 2Surgery, University of Texas Medical School at Houston, Houston, TX
Background: Many benefits of minimally invasive surgery are lost in the obese. Obese patients are reported more likely to experience complications, longer operating times, higher conversion rates, and longer lengths of stay. Robotic Assisted Laparoscopic Surgery (RALS) may offer specific benefits in this population, as technical issues seen in other platforms may not be pertinent. Our goal was compare outcomes for RALS in obese and non-obese patients.
Methods: Review of a prospective database was performed to identify patients undergoing an elective colorectal resection using a robotic assisted laparoscopic approach. Patients were stratified into obese (BMI>30 kg/m<+>2<+>) and non-obese cohorts (BMI<30 kg/m<+>2<+>). Patients were then matched on surgeon, age, gender, comorbidity, diagnosis, and procedure performed to compare groups. Demographic, perioperative, and postoperative outcome data were evaluated. The main outcome measures were the operative time, conversion rate, length of stay, and complication, readmission, and reoperation rates.
Results: Forty-five patients were evaluated in each cohort. The BMI was significantly different across groups (p<.01). All other demographic parameters were well matched. The primary diagnosis was diverticulitis (40.0%) and procedure performed an anterior rectosigmoidectomy (48.9%) in both groups (p=1.00). There were no significant differences in operative time (p=0.864), blood loss (p=0.375), intraoperative complications (p=0.54), or conversion rates (p-0.91) across the obese and non-obese cohorts. The length of stay was comparable between groups (p=0.449). Postoperatively, the complication (p=0.87), readmission (p=1.00), and reoperation rates (p=0. 0.95) were for the obese and non-obese. There were no mortalities in either group. For malignant cases (37.8%), the lymph node yield (p=0.480) and positive margins (p=1.00) were similar and acceptable in both cohorts.
Conclusions: Minimally invasive surgery has been reported as technically challenging and associated with inferior outcomes in obese patients. In our matched RALS series, we did not find longer operative times, higher conversion or complication rates, or worse postoperative outcomes between obese and non-obese patients. Thus, RALS may be a tool to help overcome the inherent challenges in the obese and help optimize patient outcomes in colorectal surgery
Perioperative and Outcome Data
| Values | Obese (n=45) | Non-obese (n=45) | p-Value | | Mean Operative time (min, SD) | 255.27 (63.57) | 252.84 (70.16) | 0.86 | | Mean Blood Loss (mL, SD) | 98.11 (61.6) | 113.89 (101.3) | 0.36 | Conversion (n, %)
| - | 1 (2.2%) | 0.91 | Intraoperative Complications (n, %)
| - | 3 (6.7%) | 0.54 | | Readmissions (n, %) | 7 (15.6%) | 7 (15.6%) | 1.00 | | Postoperative Complications (n, %) | 18 (40.0%) | 13 (28.9%) | 0.87 | | Unplanned Re-Operation (n, %) | 4 (8.9%) | 2 (4.4%) | 0.95 | | Mean Length of Stay (days, SD) | 4.18 (3.52) | 3.69 (2.48) | 0.45 | | Procedures for Malignancy (n, %) | 17 (37.8%) | 17 (37.8%) | 1.00 | | Pre-operative Chemoradiotherapy (n, %) | 13 (28.9%) | 11 (24.4%) | 0.98 | | Mean Lymph Nodes (SD) | 15.6 (9.5) | 17.9 (9.5) | 0.67 | | Positive Margins (n, %) | 2 (4.4%) | 2 (4.4%) | 1.00 |
SD- Standard Deviation; 30-day Outcomes Measured
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