456: Increased morbidity is associated with obesity in women undergoing peripartum hysterectomy

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Maternal obesity is an independent risk factor for morbidity in pregnancy and at the time of cesarean section. We hypothesized that obesity would also be an independent risk factor for morbidity at the time of peripartum hysterectomy. This is a retrospective chart review of all peripartum hysterectomies performed at a single academic institution from 1/2010-12/2014. Demographic information, labor and delivery outcomes, estimated blood loss, blood product replacement, as well as, associated complications, hospital readmissions at <30 days and mortality were collected. A total of 86 cases were reviewed, 31 (36.0%) were scheduled cases with a suspected morbidly adherent placenta diagnosed pre-operatively and 55 (64%) were unplanned. The most common indications for peripartum hysterectomy were morbidly adherent placenta with 69 (80%) meeting pathologic criteria for accreta/increta/percreta and 15 (17%) with ultimate pathologic diagnosis of atony alone. The average BMI in this cohort was 31.6 with 38 patients (44.2%) meeting criteria for obesity (BMI >30) and 13 (15%) for Class III obesity (BMI >40). Patients with Class III obesity had increased rates of ICU admission with 84.6% of patients admitted to ICU having BMI >40 compared to 47.9% of patients with BMI <40 (p = 0.017). In the multivariate analysis, the relationship between Class III obesity and ICU admission remained significant after controlling for EBL, development of DIC and product replacement with >4U RBCs. Patients requiring readmission at <30 days had higher BMI than those that did not (40.6 vs 31.0, p= 0.0051). The probability of readmission stratified by BMI showed an exponential relationship with an upward inflection point around BMI=38, and probabilities exceeding 10% for those patients with a BMI > 40 (figure 1). Our study demonstrates that Class III obesity is an independent risk factor for increased morbidity at the time of peripartum hysterectomy including need for ICU admission and readmission within 30 days. As peripartum hysterectomy is an increasingly common obstetric procedure, there has been a push to standardize practices and protocols to decrease associated morbidity and mortality. Maternal obesity represents an under-recognized source of potentially preventable morbidity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)