Impact of Obesity on Outcomes of Hysterectomy

Abstract

Study Objectives To evaluate the impact of obesity on complications of hysterectomy Study Design Retrospective cohort study Design Classification Canadian Task Force II-2 Setting Department of Obstetrics and Gynecology, Women and Infants Hospital of Rhode Island (WIH) Patients Patients who had a hysterectomy at WIH between July 2006 and January 2009 Intervention Hysterectomy by any mode Measurements and Main Results We collected data from medical records of all laparoscopic hysterectomies during the time period and collected data from a random subset of abdominal and vaginal hysterectomies. The independent variable, body mass index, was grouped according to World Health Organization guidelines. A composite of surgical complications was generated. Multivariable logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals. We collected data from 907 hysterectomies and 29.9% (n=267) of the population was obese. Eighteen percent of patients (n=154) had at least one complication. Compared to non-obese women, obese women were at increased odds of having any complication (OR 1.62, 95% CI 1.12-2-34). Performing subgroup analyses by mode of hysterectomy and controlling for confounding factors, we were unable to detect differences odds of complications between obese and non-obese women who underwent either an abdominal, vaginal, or laparoscopic hysterectomy. Conclusion In our study, we found that among women who had a hysterectomy, obese women had a higher rate of complications than non-obese women.

Differences in Postoperative Morbidity among Obese Patients Undergoing Abdominal Versus Laparoscopic Hysterectomy for Benign Indications

“…Obesity accounts for higher medical costs and is associated with an array of medical conditions [5]. Specifically, for patients undergoing surgery, increasing BMI is associated with increased operative time, longer nonsurgical operating room (OR) time, higher estimated blood loss, and other significant operative complications [6]. Recent evidence suggests that 43% of women in the United States who undergo hysterectomy for benign disease are obese [7].…”

Does Obesity and Procedure Type Increase the Risk of In-Hospital Mortality in Laparoscopic Hysterectomy: A Report From the United States Hospitals

“…Studies exploring the complication rates in obese and non-obese patients have produced conflicting results. Some have found increased complications and laparo-conversions in obese patients, while other studies suggest that there are no relevant differences between the weight groups [9,10,21]. In a review of 2,530 laparoscopic hysterectomies, those with a BMI higher than 30 kilograms/square meter had a two-fold risk of unintended laparotomy [20,22].…”

Effect of body mass index on maternal morbidity following peripartum hysterectomy

“…Obesity is considered an independent risk factor in the post‐operative period for medical and surgical complications such as venous thromboembolism . While there is no literature available to compare BMI category and surgical risk in women undergoing a peripartum hysterectomy, gynaecologic hysterectomies in obese women have been associated with increased morbidity, including an increase in operative time, blood loss and infectious complications .…”