67.06 Extreme Obesity Increases Surgical Site Infections But Not Major Complications After Renal Surgery

Posted on January 18, 2016

M. A. Mann1, M. Grimes1, M. L. Blute1, K. Zorn1, T. M. Downs1, S. L. Best1, F. Shi1, D. F. Jarrard1, S. Y. Nakada1, E. Abel1 1University Of Wisconsin,Urology,Madison, WI, USA

Introduction: Extreme or class 3 obesity (BMI ≥ 40) may be associated with increased morbidity following surgery. The objective of this study was to evaluate if patients with extreme obesity had worse perioperative outcomes following renal surgery.

Methods: Comprehensive medical records were reviewed for all patients treated with partial nephrectomy, radical nephrectomy or nephroureterectomy at our institution from 2000-2014. Complications occurring within 90 days were recorded and classified according to the Clavien-Dindo system. Univariable and multivariable models were used to evaluate the association of obesity with major complications (≥Clavien 3a), surgical site infections (SSI), blood transfusion (BT) rates and readmission rates.

Results: A total of 1109 patients were evaluated including 114 (10.3%) patients with BMI ≥40. Perioperative complications were identified in 279 (25.5%) patients including major complications in 80 (7.3%). Patients with BMI ≥40 were not at increased risk for major complications (p=0.2). Independent predictors of major complications included Charlson Comorbidity Index and surgical approach (open vs. minimally invasive).

A total of 217 (19.6%) patients received BT during the initial hospitalization following surgery. BMI ≥40 was not associated with increased risk of BT (p=0.9) SSI were observed in 60 (5.5%) patients. Patients with BMI ≥40 had an increased risk of SSI, OR 2.3 (95% CI 1.2-4.5).

A total of 59 patients (5.4%) were readmitted to the hospital with 30 days following surgery. BMI ≥40 was not associated with increased risk of readmission (p=0.4)

Conclusion: Extreme obesity is associated with increased risk of wound complications but not a higher risk of major complications, BT, or hospital readmission following renal surgery. When feasible, minimally invasive surgery may be associated with lower major complication rates.