Intraoperative and Postoperative Complications Rate Following Elective Pelvic Reconstructive Surgery in Women with Severe Obesity: A Retrospective Cohort Study.

Abstract

Introduction and hypothesis: To assess early intraoperative and postoperative complications and outcomes in patients with severe obesity undergoing apical prolapse repair compared with patients with normal weight.

Methods: This retrospective cohort study included 315 patients who underwent apical prolapse repair at a tertiary medical center between 2009 and 2024. Fifty-six patients had a BMI greater than 40, and 259 had a normal BMI (18.5-30). Patients with class I and II obesity were excluded from the study. Preoperative data, surgical details, and 30-day postoperative complications were collected and analyzed.

Results: The average age of the patients with severe obesity was significantly lower than that of patients with normal weight (56.6 vs 64.1 years, p < 0.001). Patients with severe obesity had a higher prevalence of diabetes (27.3% vs 9.0%, p < 0.001), hypertension (54.5% vs 25.1%, p < 0.001), and obstructive sleep apnea (21.8% vs 7.4%, p = 0.001). Intraoperatively, the group with severe obesity experienced greater estimated blood loss (233.6 ml vs 115.2 ml, p < 0.001) and were more likely to undergo concurrent incontinence procedures (76.4% vs 51.3%, p = 0.001). However, no significant difference in intraoperative complications was observed between the groups (5.4% vs 5.4%, p = 1.000). Hospitalization duration was longer in patients with morbid obesity. Total complication rate within 30 days was 7.3%, with no statistically significant difference between the groups with severe obesity and normal weight.

Conclusion: Patients with severe obesity undergoing vaginal apical prolapse repair have similar rates of early postoperative complications and health care encounters to patients with normal weight. These findings support offering prolapse surgery to patients with morbid obesity when clinically indicated.