title: Robotic Hysterectomy for Endometrial Cancer in Obese Patients With Comorbidities: Evaluating Postoperative Complications.
abstract: OBJECTIVE
  The objective of this study is to determine (1) if there is a relationship between increasing body mass index (BMI) and postoperative complications in patients undergoing robotic hysterectomy for endometrial cancer and (2) if there are additional patient characteristics, specifically preoperative comorbidities, which increase the risk of postoperative complication
  
  
  METHODS
  A retrospective chart review was conducted on women who underwent a robotic staging surgery for endometrial cancer from 2006 to 2012. Basic demographics and preoperative and postoperative complications were extracted from the medical records. Obesity was divided into 4 categories, and complication rates were compared across these subgroups. Patients were also divided by the number of comorbidities and compared.
  
  
  RESULTS
  The cohort included 543 patients. The BMI ranged from 17.3 to 69.5 kg/m. Three hundred eighty patients (70%) were obese (BMI >30 kg.m). One hundred ninety patients (35%) had no comorbidities other than obesity, and 180 patients (33%) had only 1 comorbidity other than obesity (Table 1).Postoperative complications occurred in 102 (18.7%) of the patients. Severe postoperative complications, including intensive care unit admission, reintubation, reoperation, and perioperative death, occurred in 14 patients (2.6%). Of the nonobese patients, 27 (16.5%) had postoperative complications; of the obese patients, 75 (19.7%) had a complication (P = 0.38). In patients with no comorbidities, 16.3% had a complication; 18% of patients with 1 to 2 comorbidities had a complication, and 28% of patients with 3 or more comorbidities had a complication (P = 0.08).
  
  
  CONCLUSIONS
  The postoperative complication rate based on BMI or number of comorbidities was not statistically significant, but patients with greater number of comorbidities had an increased rate of postoperative complications. Patients with certain comorbidities, cardiac and renal specifically, had the highest rates of postoperative complications.
authors.affiliation: *Department of Obstetrics and Gynecology, Division of Gynecology Oncology, The Ohio State University College of Medicine, Columbus, OH; and †University of Texas Health Science Center at San Antonio, San Antonio, TX.
authors.forename: Floor J
authors.initials: FJ
authors.lastname: Backes
authors.forename: Maggie
authors.initials: M
authors.lastname: Rosen
authors.forename: Margaret
authors.initials: M
authors.lastname: Liang
authors.forename: Georgia A
authors.initials: GA
authors.lastname: McCann
authors.forename: Aine
authors.initials: A
authors.lastname: Clements
authors.forename: David E
authors.initials: DE
authors.lastname: Cohn
authors.forename: David M
authors.initials: DM
authors.lastname: OʼMalley
authors.forename: Ritu
authors.initials: R
authors.lastname: Salani
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Fowler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D015897:Comorbidity; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009765:Obesity / Q000150:complications* / Q000503:physiopathology; D011183:Postoperative Complications; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D012371:Robotics