{"\ufeffBODY MASS INDEX AS A SIGNIFICANT PREDICTOR OF POSTOPERATIVE ILEUS FOLLOWING ROBOTIC RADICAL PROSTATECTOMY: INSIGHTS FROM A SINGLE-CENTER RETROSPECTIVE STUDY\nI. Aizat Sabri1, Y.M. Razaleigh1, J. Arvind1, H. Ahmad Fakhri1, C.K. Faris1, I. Muhammad Hafiz1, O. Fahmy1, M.G. Khairul Asri1, Y. Effah Leiylena2\n\n1Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia.\n2District Health Office, Kuala Nerus, Kuala Terengganu, Terengganu, Malaysia \n*Corresponding author:  \nAizat Sabri Ilias, Department of Urology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia. Email: aizat.ilias@upm.edu.my\n\nDOI: https://doi.org/10.32896/tij.v5n2.17-31\nSubmitted: 09.05.2025\nAccepted: 28.06.2025\nPublished: 30.06.2025\n \nABSTRACT: \nIntroduction\nPostoperative ileus (POI) remains a common complication following robotic-assisted radical prostatectomy (RARP), delaying recovery and increasing healthcare burden. Obesity and impaired glycemic control are recognized contributors to poor postoperative outcomes. However, their role in predicting POI, particularly in RARP, remains underexplored. \nMethod\nA retrospective analysis was conducted on 200 patients who underwent RARP between January 2020 and December 2023. Preoperative variables included BMI, HbA1c, clinical T stage, PIRADS score, prostate volume (MRI), and biopsy Gleason score. Optimal thresholds for BMI and HbA1c were determined using ROC analysis and Youden\u2019s J statistic. A six-point scoring system was developed based on categorical cutoffs, with logistic regression and ROC analysis used to evaluate performance.\nResults\nThe overall incidence of POI was 17%. Novel thresholds\u2014BMI \u226531.0 kg/m\u00b2 and HbA1c \u22658.0%\u2014were independently associated with higher POI risk. The additive score (range 0\u20136) showed progressive increases in POI incidence with higher scores. \nConclusion\nThe resulting score offers a practical, bedside tool to support early risk stratification and preoperative counseling. Its simplicity supports clinical integration, and future multicenter validation may enhance predictive accuracy and expand its utility in enhanced recovery protocols.\n\nKeywords: Postoperative ileus, robotic-assisted radical prostatectomy, body mass index\n\nINTRODUCTION\nRobotic-assisted radical prostatectomy (RRP) has become the standard surgical treatment for prostate cancer due to enhanced recovery and minimized invasiveness. However, postoperative ileus (POI), characterized by delayed bowel function recovery, remains a significant barrier to optimal patient outcomes. Current literature has established broad correlations between obesity and postoperative complications but lacks specific BMI thresholds related explicitly to POI following RRP. Furthermore, the roles of diabetes mellitus and detailed oncological factors remain under-explored in this surgical setting. The current study addresses these knowledge gaps by establishing, for the first time, a definitive BMI cutoff predictive of POI, along with other relevant clinical and oncological risk factors.\n\nMETHODOLOGY\nA retrospective review was performed on 200 patients undergoing RRP from January 2020 to December 2023. Data collected included demographics (age, ethnicity), clinical variables (BMI, DM status), perioperative parameters (hospital stay length, postoperative hemoglobin), and detailed oncological characteristics (MRI T stage, presence of cribriform pattern, pathological T stage, prostate volume, and surgical margins), as shown in Table 1. Statistical analysis was performed using SPSS Version 26. Continuous variables were compared using independent t-tests or Mann-Whitney U tests. Categorical data were analyzed using chi-square or Fisher\u2019s exact test. ROC curve analysis was conducted to identify optimal BMI and HbA1c thresholds associated with POI using Youden\u2019s J statistic. Multivariable logistic regression was used to identify independent predictors. Significance was set at p<0.05. \nTo enhance the clinical utility of the findings, a simplified predictive risk score for POI based exclusively on preoperative data was developed. This model integrates six readily available clinical parameters: BMI, HbA1c, clinical T stage, PIRADS score, prostate volume (MRI), and biopsy Gleason score. Each variable was assigned one point if a pre-established risk threshold was met, yielding a total score range from 0 to 6, as seen in Table 2.\nTo enhance the usability of the scoring model, each risk factor was assigned an equal weight of 1 point in the final scoring system.\nAfter then, to  further evaluate model performance, patients were stratified into risk categories based on total scores: Low Risk (0\u20132), Moderate Risk (3\u20134), and High Risk (5\u20136). The majority of patients fell into the low or moderate risk groups in this cohort. Postoperative ileus incidence rose progressively from 13.8% in the Low Risk group to 22.2% in the Moderate Risk group. No patients in this dataset had scores within the High Risk category. \nFinally, to assess the discriminative ability of the proposed preoperative risk score, a receiver operating characteristic (ROC) curve was generated using the total score (0\u20136) against the binary outcome of postoperative ileus.\n\nRESULTS\nThe overall POI incidence was 17%. ROC analysis identified BMI \u226531.0 kg/m\u00b2 (AUC": null}