Association of body mass index with surgical complications after minimally invasive hysterectomy.

Purpose: To study the association between body mass index (BMI) and short-term postoperative complications of patients undergoing laparoscopic hysterectomy (LH).

Study design: This is a cohort study of patients who underwent LH for benign conditions. We used prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2012 to 2020. We categorized patients into BMI subgroups and compared 30-day postoperative complication rates, defined by the Clavien-Dindo classification.

Results: 206,944 patients met inclusion criteria. In multivariable regression analysis, when comparing lower and higher BMI subgroups, there was a statistically significant increase in any complications [< / ≥ 35.0 kg/m², aOR 95% CI 1.06(1.01-1.10)] and minor complications [< / ≥ 35.2 kg/m², aOR 95% CI 1.13(1.07-1.19)] in the higher BMI group but no differences in major complications. When comparing obesity categories 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] compared to normal weight individuals. Patients in 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] 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 min, p < 0.05).

Conclusions: Higher BMI was associated with a higher risk of any and minor complications than lower BMI in patients undergoing LH, as well as increased operative time. When comparing specific BMI categories, overweight and obesity categories were associated with lower risks of major complications compared to the normal BMI category. WHAT DOES THIS STUDY ADDS TO THE CLINICAL WORK?: Among women undergoing minimally invasive hysterectomy for benign indications, higher BMI classes were associated with lower risk of short-term postoperative complication compared to the normal BMI class. This information can be used in preoperative planning, counseling, and shared-decision making.