Association of Body Mass Index With Surgical Complications After Laparoscopic Hysterectomy

Abstract

Study Objective

To study the association between BMI and short-term postoperative complications of patients undergoing minimally invasive (MIS) hysterectomy.

Design

A cohort study of prospectively collected data.

Setting

American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2012 – 2020.

Patients or Participants

Patients requiring MIS hysterectomy for benign conditions.

Interventions

MIS hysterectomy.

Measurements and Main Results

We categorized patients who had undergone MIS hysterectomy into body mass index (BMI) subgroups according to World Health Organization classification and compared rates of 30-day postoperative major and minor complications, defined according to the Clavien-Dindo classification, across BMI groups.

A total of 206,944 patients met the inclusion criteria. In multivariable regression analysis, when comparing those with low and high BMI there was a statistically significant increase in any complications [aOR 95%CI 1.06(1.01-1.10)] and minor complications [aOR 95%CI 1.13(1.07-1.19)] in the high BMI group but no differences in major complications across the two groups [aOR 95%CI 0.96(0.88-1.04)].

When comparing classes of obesity to the normal BMI group, Class I, II, and III categories had a lower likelihood of major complications [aOR 95%CI 0.87(0.80-0.93), 0.84(0.77-0.91), 0.82(0.75-0.90), and 0.83(0.75-0.91), respectively] when compared to normal weight individuals. However, patients in the Class II and III categories had a higher likelihood of minor complications [aOR 95%CI 1.12(1.03-1.21), and 1.17(1.08-1.28), respectively] when compared to normal weight individuals.

The mean operative time was significantly longer for each BMI group compared to lower BMI groups (range 115.2-144.5 minutes, p<0.05).

Conclusion

Higher BMI was associated with a higher risk of all complications and minor complications than low BMI in patients undergoing MIS hysterectomy, as well as increased operative time. However, when comparing across specific BMI categories, overweight and obesity categories were associated with lower risks of major complications compared to the normal BMI category. These findings can help in preoperative patient counseling.