title: Evaluation of the impact of body mass index on outcome among renal mass patients treated with hand-assisted laparoscopic radical nephrectomy.
abstract: OBJECTIVE
  Although there are empiric data to show that obesity is not a contraindication for laparoscopic radical nephrectomy, similar data are lacking for the use of hand-assisted laparoscopic radical nephrectomy (HALRN) in obese patients. We evaluate whether obese patients undergoing HALRN to manage a renal mass are more likely than nonobese patients to experience poor intraoperative and perioperative outcomes.
  
  
  METHODS
  Between June 1, 1999, and May 31, 2006, 150 patients underwent HALRN for the management of a solid renal mass at our institution. We abstracted detailed demographic, clinical, and follow-up data on all patients in this cohort. As our primary analysis, we evaluated associations between body mass index (BMI) and estimated blood loss, operative time, length of stay, and complications using linear and logistic regression models.
  
  
  RESULTS
  There was no evidence that obese patients experienced a statistically significant or clinically relevant increase in blood loss (P = 0.97), operative times (P = 0.87) or length of stay (P = 0.62) compared with persons of normal weight. In contrast, although there was no evidence of a linear trend toward complications in patients with a higher BMI (P = 0.19), obese patients were almost three times more likely to experience a complication compared with normal-weight persons (odds ratio: 2.88; 95% confidence interval: 1.01-8.16). Adjusting for relevant clinical covariates individually did not markedly alter these associations.
  
  
  CONCLUSIONS
  Obesity is not a contraindication for HALRN to manage a renal mass; however, obese patients should be aware that they may be at increased risk for certain complications after surgery, notably ileus and incisional hernias.
authors.affiliation: Department of Urology, Mayo Clinic Jacksonville, Jacksonville, Florida 3222, USA. parker.alexander@mayo.edu
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Parker
authors.forename: Richard
authors.initials: R
authors.lastname: Lewis
authors.forename: Michael G
authors.initials: MG
authors.lastname: Heckman
authors.forename: Nancy H
authors.initials: NH
authors.lastname: Diehl
authors.forename: Theodore
authors.initials: T
authors.lastname: Brisson
authors.forename: Raymond
authors.initials: R
authors.lastname: Pak
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wehle
mesh_terms: D000368:Aged; D015992:Body Mass Index; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D009765:Obesity / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome