During Hysterectomy, Obesity Does Not Increase Complications Risk

Greater BMI in individuals undergoing hysterectomy for benign, nonurgent indications does not increase the risk of complications or adverse outcomes, according to the results of a recent retrospective review.

Included were 2528 individuals undergoing hysterectomy by 67 surgeons from July 2016 to June 2019 at 7 hospitals in Ontario, Canada. Excluded from the study were hysterectomies during the study period that were premalignant, malignant, or emergent. A total of 33% (n = 828) of patients had a BMI within normal limits, 35% (n = 889) had overweight, 20% (n = 500) had obesity class 1, 8% (n = 205) had obesity class 2, and 4% (n = 106) had obesity class 3. All participants were evaluated by BMI class, as well as hysterectomy route (ie, abdominal, laparoscopic, and vaginal).

Any complications or readmission to the hospital were the primary outcomes. Grade 2 or greater complications, postoperative emergency department visits, hospital readmission, operative time, and estimated blood loss were among the secondary outcomes.

In addition to the primary and secondary outcomes, the researchers examined patient characteristics, surgical factors, and surgeon characteristics. Included in patient characteristics were age, American Society of Anesthesiologists (ASA) physical status classification, preoperative diagnoses, preoperative anemia, and prior surgeries. Surgical factors included endometriosis, adhesions, uterine weight, and concomitant procedures. The volume of surgery, fellowship/generalist training, and type of hospital were among the surgeon characteristics.

The results indicated that individuals with obesity had higher ASA classifications and more prior surgeries compared with patients with a BMI within normal limits. Individuals with class 2 and 3 obesity were younger, had greater uterine weight, and had more intraoperative adhesions than those with a BMI within normal limits.

Further, only individuals with class 2 obesity who underwent vaginal hysterectomy had any differences in the odds of primary or secondary outcomes. These patients had 9.1% (11 min) longer operative times (0.091; 95% CI; 0.002 – 0.18, p < .05) compared with those with a BMI within normal limits. Individuals with overweight also had 28 mL significantly less estimated blood loss (-0.154; 95% CI; -0.26 - -0.05, p < .01) than patients with a BMI within normal limits. 

“BMI was not independently associated with surgical quality outcomes in patients undergoing hysterectomy for benign, non-urgent indications. Abdominal, laparoscopic, and vaginal hysterectomy can be performed safely in overweight and obese patients.”

—Leigh Precopio

Reference:

Cybulsky Murji A, Sunderji Z, Shapiro J, Elliott C, Shirreff L. Assessing the impact of obesity on surgical quality outcomes among patients undergoing hysterectomy for benign, non-urgent indications. Eur J Obstet Gynecol. Published online May 23, 2022. doi:10.1016/j.ejogrb.2022.05.024