MP38-12 PREHABILITATION BODY MASS INDEX (BMI) TARGET FOR COMPLICATION RISK REDUCTION FOLLOWING RADICAL CYSTECTOMY

You have accessJournal of UrologyBladder Cancer: Epidemiology & Evaluation I (MP38)1 Sep 2021MP38-12 PREHABILITATION BODY MASS INDEX (BMI) TARGET FOR COMPLICATION RISK REDUCTION FOLLOWING RADICAL CYSTECTOMY Louise C. McLoughlin, Wassim Kassouf, Rodney H. Breau, Adrian Fairey, Agnihotram V. Ramanakumar, Afsar Salimi, Eric Hyndman, Darrel E. Drachenberg, Jonathan Izawa, Bobby Shayegan, Jean-Baptiste Lattouf, Michele Lodde, Ricardo Rendon, Robert Siemens, Claudio Jeldres, Peter Black, and Girish S. Kulkarni Louise C. McLoughlinLouise C. McLoughlin More articles by this author , Wassim KassoufWassim Kassouf More articles by this author , Rodney H. BreauRodney H. Breau More articles by this author , Adrian FaireyAdrian Fairey More articles by this author , Agnihotram V. RamanakumarAgnihotram V. Ramanakumar More articles by this author , Afsar SalimiAfsar Salimi More articles by this author , Eric HyndmanEric Hyndman More articles by this author , Darrel E. DrachenbergDarrel E. Drachenberg More articles by this author , Jonathan IzawaJonathan Izawa More articles by this author , Bobby ShayeganBobby Shayegan More articles by this author , Jean-Baptiste LattoufJean-Baptiste Lattouf More articles by this author , Michele LoddeMichele Lodde More articles by this author , Ricardo RendonRicardo Rendon More articles by this author , Robert SiemensRobert Siemens More articles by this author , Claudio JeldresClaudio Jeldres More articles by this author , Peter BlackPeter Black More articles by this author , and Girish S. KulkarniGirish S. Kulkarni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002053.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgical morbidity after radical cystectomy (RC) is significant, particularly in patients with an above-normal body mass index (BMI). Prehabilitation is a multi-modal, preoperative optimization program with nutritional optimization and weight loss as core principles, reported to reduce complications after major cancer surgery. Weight-loss-focused prehabilitation may apply to patients with an-above normal BMI with a sufficient preoperative intervention window, such as a period of neoadjuvant chemotherapy. Our study objectives are to compare complication rates between BMI categories and identify an optimum BMI target for patients with an above-normal BMI to aim for during prehabilitation to modify their risk of perioperative morbidity. METHODS: Data were extracted from the Canadian Bladder Cancer Information System (CBCIS), a prospective Canadian registry across 13 academic centers. A retrospective analysis was performed on 589 patients who underwent RC. Peri-operative (≤90 days) complications were classified by type and severity according to Clavien-Dindo classification (CDC), where available. Unconditional Logistic regression analysis was performed to determine the association between BMI and complication risk. RESULTS: The median BMI of the cohort was 27 (IQR 7), with 29% classified as having normal BMI (<25 kg/m2), 38% overweight (25-29), 21% Class I (30-35), and 12% ≥ Class II (>35) obesity. The overall complication rate was 40%. Complication detection was highest in the overweight group. Intra-operative blood loss and length of hospital stay were significantly increased in all above-normal BMI groups. Ileus, wound infection and urine leak were the most commonly detected postoperative complications. On multivariable analysis, overweight BMI was independently associated with any complications (OR 1.96, p=0.004) and urine leak (OR 5.22, p=0.034), ≥ Class II obesity BMI was associated with any complications (OR 3.49, p<0.0001), wound infection (OR 6.31, p<0.0001), fascial dehiscence (OR 5.57, p=0.027) and urine leak (OR 5.69, p=0.044). The Class 1 obesity group was not significantly associated with complications (OR 1.38, p=0.259). CONCLUSIONS: This study demonstrates the feasibility of utilizing a national bladder cancer database to record and evaluate RC complications. Overweight and Class II obesity BMI groups were significantly associated with perioperative morbidity. These groups may benefit from a targeted weight-loss intervention during prehabilitation, where feasible, to reduce risk of perioperative morbidity following RC. Source of Funding: This project has been supported by the CBCIS Collaborative and by Bladder Cancer Canada. CBCIS has received unrestricted grants and/or in-kind support from: Bladder Cancer Canada, Merck, Roche, Astra Zeneca, Pfizer/EMD Serono, and Bristol-Myers Squibb. There is no direct role or influence from this funding on this work © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e698-e699 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Louise C. McLoughlin More articles by this author Wassim Kassouf More articles by this author Rodney H. Breau More articles by this author Adrian Fairey More articles by this author Agnihotram V. Ramanakumar More articles by this author Afsar Salimi More articles by this author Eric Hyndman More articles by this author Darrel E. Drachenberg More articles by this author Jonathan Izawa More articles by this author Bobby Shayegan More articles by this author Jean-Baptiste Lattouf More articles by this author Michele Lodde More articles by this author Ricardo Rendon More articles by this author Robert Siemens More articles by this author Claudio Jeldres More articles by this author Peter Black More articles by this author Girish S. Kulkarni More articles by this author Expand All Advertisement PDF downloadLoading ...

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