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BMI may increase complications for prolapse surgery

Opinion
Video

"I don't think 1 database study creates dogma, but I do think we can share these data with our patients and talk to them about treatment options and risk, have that difficult conversation about how BMI may be associated with that risk," says Cassandra K. Kisby, MD, MS.

In this video, Cassandra K. Kisby, MD, MS, discusses the take-home message from the Urogynecology study “Impact of Severe Obesity on Major Perioperative Complications for Prolapse Surgery.” Kisby is an assistant professor of obstetrics and gynecology, obstetrics and gynecology, and urogynecology at Duke University in Durham, North Carolina.

Transcription:

What are some next steps following this research?

I don't want to overstate our outcomes, because this really is a national database study. It's a good place to start, but I think it would be optimal to have a multicenter prospective study looking to see if there's a similar association. Furthermore, we use BMI as a dichotomous variable, and there are some statistical downsides to that. There are a lot of more complex modeling techniques that I think could be utilized to evaluate associations.

What is the take-home message for the practicing urologist?

I don't think 1 database study creates dogma, but I do think we can share these data with our patients and talk to them about treatment options and risk, have that difficult conversation about how BMI may be associated with that risk. For some patients, this will be motivating. They might opt for lifestyle changes prior to their prolapse surgery. However, [for] patients who do have a BMI over 40 [and] opt for laparoscopic or robotic surgery for their prolapse, I would thoroughly counsel them on risks as well as involve their primary care providers or any subspecialist providers who are caring for them to optimize any of their medical comorbidities.

Is there anything you would like to add?

It's our job and we took an oath to do no harm, and we as surgeons, we really want to fix things, we want to fix the prolapse. We need to have the hard conversations about some sensitive topics though around surgery, things like weight and perioperative morbidity. And when these things are broached very gracefully, patients often appreciate it and are thankful for the information.

This transcription was edited for clarity.

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