Effect of baseline obesity and postoperative weight gain on the risk of channel revision following continent catheterizable urinary channel surgery

Katherine Chan, Konrad Szymanski, Xiaochun Li, Susan Ofner, Chandra Flack, Benjamin Judge, Benjamin Whittam, Rosalia Misseri, Martin Kaefer, Richard C. Rink, Mark P. Cain

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective Prior studies suggest that obese patients are at increased risk for complications following continent catheterizable urinary (CCU) channel surgery. We hypothesized that postoperative weight gain increases the risk of channel angulation, difficulty catheterizing, and possible channel perforation requiring subfascial revision. The purpose of this study was to evaluate whether baseline obesity or becoming overweight/obese postoperatively was associated with a greater risk of subfascial revision. Method We reviewed retrospectively an institutional database of patients who underwent CCU channel surgery between the ages of ≥2 and <20 years from January 1990 to May 2013, excluding those with continent urinary reservoirs, continent vesicostomies, and those without body mass index (BMI) data. We collected data on patient/procedure characteristics, baseline/most recent BMI, and subfascial revision(s). We used Cox proportional hazard multivariable regression to assess the association of being overweight/obese at baseline (≥85% BMI) with time to first subfascial revision, and Fisher's exact test to compare rates of subfascial revision between those who became overweight/obese and those who did not. Results Of the patients, 328/501 (65.5%) had baseline and post-baseline BMI data available: 53.4% male, 90.6% white, median age 7.4 years; median follow-up 76.4 months. Of the 328 patients, 38 (11.6%) had subfascial revisions. Baseline BMI data were available for 378 patients, and, of these, 130 (34.4%) were overweight/obese at baseline. Overweight/obese patients were more likely to undergo umbilical Monti (10% vs. 8.1%), non-umbilical spiral Monti (33.8% vs. 13.7%), and spiral umbilical Monti channels (13.8% vs. 7.3%) versus normal/underweight patients (p < 0.0001). From a multivariable Cox proportional hazard model controlling for age, BMI category, diagnosis, and ambulatory status, the hazard of subfascial revision for spiral umbilical Monti channels was 2.1× that of other channels (hazard ratio (HR) 2.1 [95% CI 1.2–3.8], p = 0.01). Fifty-one out of 328 patients (15.6%) became overweight/obese postoperatively, with 7.8% having a subfascial revision vs. 12.3% of those whose weight category decreased or remained stable (p = 0.3) (Table 1). Conclusions Patients who were overweight/obese at baseline were more likely to have channels constructed that are at the highest risk of subfascial revision. Patients who became overweight/obese postoperatively were not at greater risk of subfascial revision. Limitations include potential bias because of differential follow-up and inaccuracy of BMI percentile as a measurement of obesity.

Original languageEnglish (US)
Pages (from-to)249.e1-249.e7
JournalJournal of Pediatric Urology
Volume12
Issue number4
DOIs
StatePublished - Aug 1 2016

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Weight Gain
Obesity
Body Mass Index
Umbilicus
Continent Urinary Reservoirs
Cystostomy
Thinness
Proportional Hazards Models
Databases
Weights and Measures

Keywords

  • Neurogenic
  • Obesity
  • Postoperative complications
  • Urinary bladder

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Urology

Cite this

Effect of baseline obesity and postoperative weight gain on the risk of channel revision following continent catheterizable urinary channel surgery. / Chan, Katherine; Szymanski, Konrad; Li, Xiaochun; Ofner, Susan; Flack, Chandra; Judge, Benjamin; Whittam, Benjamin; Misseri, Rosalia; Kaefer, Martin; Rink, Richard C.; Cain, Mark P.

In: Journal of Pediatric Urology, Vol. 12, No. 4, 01.08.2016, p. 249.e1-249.e7.

Research output: Contribution to journalArticle

Chan, Katherine ; Szymanski, Konrad ; Li, Xiaochun ; Ofner, Susan ; Flack, Chandra ; Judge, Benjamin ; Whittam, Benjamin ; Misseri, Rosalia ; Kaefer, Martin ; Rink, Richard C. ; Cain, Mark P. / Effect of baseline obesity and postoperative weight gain on the risk of channel revision following continent catheterizable urinary channel surgery. In: Journal of Pediatric Urology. 2016 ; Vol. 12, No. 4. pp. 249.e1-249.e7.
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title = "Effect of baseline obesity and postoperative weight gain on the risk of channel revision following continent catheterizable urinary channel surgery",
abstract = "Objective Prior studies suggest that obese patients are at increased risk for complications following continent catheterizable urinary (CCU) channel surgery. We hypothesized that postoperative weight gain increases the risk of channel angulation, difficulty catheterizing, and possible channel perforation requiring subfascial revision. The purpose of this study was to evaluate whether baseline obesity or becoming overweight/obese postoperatively was associated with a greater risk of subfascial revision. Method We reviewed retrospectively an institutional database of patients who underwent CCU channel surgery between the ages of ≥2 and <20 years from January 1990 to May 2013, excluding those with continent urinary reservoirs, continent vesicostomies, and those without body mass index (BMI) data. We collected data on patient/procedure characteristics, baseline/most recent BMI, and subfascial revision(s). We used Cox proportional hazard multivariable regression to assess the association of being overweight/obese at baseline (≥85{\%} BMI) with time to first subfascial revision, and Fisher's exact test to compare rates of subfascial revision between those who became overweight/obese and those who did not. Results Of the patients, 328/501 (65.5{\%}) had baseline and post-baseline BMI data available: 53.4{\%} male, 90.6{\%} white, median age 7.4 years; median follow-up 76.4 months. Of the 328 patients, 38 (11.6{\%}) had subfascial revisions. Baseline BMI data were available for 378 patients, and, of these, 130 (34.4{\%}) were overweight/obese at baseline. Overweight/obese patients were more likely to undergo umbilical Monti (10{\%} vs. 8.1{\%}), non-umbilical spiral Monti (33.8{\%} vs. 13.7{\%}), and spiral umbilical Monti channels (13.8{\%} vs. 7.3{\%}) versus normal/underweight patients (p < 0.0001). From a multivariable Cox proportional hazard model controlling for age, BMI category, diagnosis, and ambulatory status, the hazard of subfascial revision for spiral umbilical Monti channels was 2.1× that of other channels (hazard ratio (HR) 2.1 [95{\%} CI 1.2–3.8], p = 0.01). Fifty-one out of 328 patients (15.6{\%}) became overweight/obese postoperatively, with 7.8{\%} having a subfascial revision vs. 12.3{\%} of those whose weight category decreased or remained stable (p = 0.3) (Table 1). Conclusions Patients who were overweight/obese at baseline were more likely to have channels constructed that are at the highest risk of subfascial revision. Patients who became overweight/obese postoperatively were not at greater risk of subfascial revision. Limitations include potential bias because of differential follow-up and inaccuracy of BMI percentile as a measurement of obesity.",
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author = "Katherine Chan and Konrad Szymanski and Xiaochun Li and Susan Ofner and Chandra Flack and Benjamin Judge and Benjamin Whittam and Rosalia Misseri and Martin Kaefer and Rink, {Richard C.} and Cain, {Mark P.}",
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T1 - Effect of baseline obesity and postoperative weight gain on the risk of channel revision following continent catheterizable urinary channel surgery

AU - Chan, Katherine

AU - Szymanski, Konrad

AU - Li, Xiaochun

AU - Ofner, Susan

AU - Flack, Chandra

AU - Judge, Benjamin

AU - Whittam, Benjamin

AU - Misseri, Rosalia

AU - Kaefer, Martin

AU - Rink, Richard C.

AU - Cain, Mark P.

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Objective Prior studies suggest that obese patients are at increased risk for complications following continent catheterizable urinary (CCU) channel surgery. We hypothesized that postoperative weight gain increases the risk of channel angulation, difficulty catheterizing, and possible channel perforation requiring subfascial revision. The purpose of this study was to evaluate whether baseline obesity or becoming overweight/obese postoperatively was associated with a greater risk of subfascial revision. Method We reviewed retrospectively an institutional database of patients who underwent CCU channel surgery between the ages of ≥2 and <20 years from January 1990 to May 2013, excluding those with continent urinary reservoirs, continent vesicostomies, and those without body mass index (BMI) data. We collected data on patient/procedure characteristics, baseline/most recent BMI, and subfascial revision(s). We used Cox proportional hazard multivariable regression to assess the association of being overweight/obese at baseline (≥85% BMI) with time to first subfascial revision, and Fisher's exact test to compare rates of subfascial revision between those who became overweight/obese and those who did not. Results Of the patients, 328/501 (65.5%) had baseline and post-baseline BMI data available: 53.4% male, 90.6% white, median age 7.4 years; median follow-up 76.4 months. Of the 328 patients, 38 (11.6%) had subfascial revisions. Baseline BMI data were available for 378 patients, and, of these, 130 (34.4%) were overweight/obese at baseline. Overweight/obese patients were more likely to undergo umbilical Monti (10% vs. 8.1%), non-umbilical spiral Monti (33.8% vs. 13.7%), and spiral umbilical Monti channels (13.8% vs. 7.3%) versus normal/underweight patients (p < 0.0001). From a multivariable Cox proportional hazard model controlling for age, BMI category, diagnosis, and ambulatory status, the hazard of subfascial revision for spiral umbilical Monti channels was 2.1× that of other channels (hazard ratio (HR) 2.1 [95% CI 1.2–3.8], p = 0.01). Fifty-one out of 328 patients (15.6%) became overweight/obese postoperatively, with 7.8% having a subfascial revision vs. 12.3% of those whose weight category decreased or remained stable (p = 0.3) (Table 1). Conclusions Patients who were overweight/obese at baseline were more likely to have channels constructed that are at the highest risk of subfascial revision. Patients who became overweight/obese postoperatively were not at greater risk of subfascial revision. Limitations include potential bias because of differential follow-up and inaccuracy of BMI percentile as a measurement of obesity.

AB - Objective Prior studies suggest that obese patients are at increased risk for complications following continent catheterizable urinary (CCU) channel surgery. We hypothesized that postoperative weight gain increases the risk of channel angulation, difficulty catheterizing, and possible channel perforation requiring subfascial revision. The purpose of this study was to evaluate whether baseline obesity or becoming overweight/obese postoperatively was associated with a greater risk of subfascial revision. Method We reviewed retrospectively an institutional database of patients who underwent CCU channel surgery between the ages of ≥2 and <20 years from January 1990 to May 2013, excluding those with continent urinary reservoirs, continent vesicostomies, and those without body mass index (BMI) data. We collected data on patient/procedure characteristics, baseline/most recent BMI, and subfascial revision(s). We used Cox proportional hazard multivariable regression to assess the association of being overweight/obese at baseline (≥85% BMI) with time to first subfascial revision, and Fisher's exact test to compare rates of subfascial revision between those who became overweight/obese and those who did not. Results Of the patients, 328/501 (65.5%) had baseline and post-baseline BMI data available: 53.4% male, 90.6% white, median age 7.4 years; median follow-up 76.4 months. Of the 328 patients, 38 (11.6%) had subfascial revisions. Baseline BMI data were available for 378 patients, and, of these, 130 (34.4%) were overweight/obese at baseline. Overweight/obese patients were more likely to undergo umbilical Monti (10% vs. 8.1%), non-umbilical spiral Monti (33.8% vs. 13.7%), and spiral umbilical Monti channels (13.8% vs. 7.3%) versus normal/underweight patients (p < 0.0001). From a multivariable Cox proportional hazard model controlling for age, BMI category, diagnosis, and ambulatory status, the hazard of subfascial revision for spiral umbilical Monti channels was 2.1× that of other channels (hazard ratio (HR) 2.1 [95% CI 1.2–3.8], p = 0.01). Fifty-one out of 328 patients (15.6%) became overweight/obese postoperatively, with 7.8% having a subfascial revision vs. 12.3% of those whose weight category decreased or remained stable (p = 0.3) (Table 1). Conclusions Patients who were overweight/obese at baseline were more likely to have channels constructed that are at the highest risk of subfascial revision. Patients who became overweight/obese postoperatively were not at greater risk of subfascial revision. Limitations include potential bias because of differential follow-up and inaccuracy of BMI percentile as a measurement of obesity.

KW - Neurogenic

KW - Obesity

KW - Postoperative complications

KW - Urinary bladder

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