Impact of High Body Mass Index on Perioperative Complications of Hysterectomies Using a National Registry Database [25I]

Abstract

INTRODUCTION: To evaluate the impact of high body mass index (BMI) on perioperative outcomes following hysterectomies reported to the National Surgical Quality Improvement Program (NSQIP). METHODS: Retrospective analysis of NSQIP database Participant Use Data File (PUF) from 2012 to 2016. Patient characteristics and perioperative complications were evaluated across BMI groups, combining normal and overweight (N/O) group, and utilizing standard definitions for class I, II and III obesity. ICD 9/10 and CPT codes were utilized. Patients were stratified into four groups based on benign vs. malignant diagnosis, and open vs. minimally invasive (MIS) procedure. Exclusion criteria were invalid CPT codes, BMI < 18, or missing data. Cochran-Armitage trend tests were used to examine linear trends in rates across increasing BMI category. RESULTS: Of 202,929 hysterectomies, 173,669 (85.6%) were eligible for analysis. Increases in obesity over time were noted with 50.5% classified as obese in 2016 vs. 46.5% in 2012 (p<0.001). For all procedures, as BMI category increased the rate of wound complication increased. In benign disease, overall complication rates also increased with BMI (MIS: 7.7% in normal BMI to 9.31% in class III, Open: 14% to 22.4%; p < 0.001). In open procedures, wound, sepsis, and readmission rates increased for obese patients, regardless of diagnosis (p < 0.001). CONCLUSION: Hysterectomy procedures for obese women were associated with increased perioperative complications. Obese patients had higher rates of wound complications regardless of surgical approach or diagnosis, and had higher rates of sepsis and readmission in open procedures regardless of diagnosis.