Assessing the Impact of Obesity on Surgical Quality Outcomes Among Women Undergoing Hysterectomy for Benign, Non-Urgent Indications

Abstract

<h3>Study Objective</h3> Evaluate impact of obese body mass index (BMI) on surgical quality metrics for patients undergoing hysterectomy for benign, non-urgent indications. <h3>Design</h3> Multicenter, retrospective review. <h3>Setting</h3> Seven hospitals in Ontario, Canada (4 academic, 3 community). <h3>Patients or Participants</h3> 2528 patients undergoing hysterectomy from July 2016 to December 2019. <h3>Interventions</h3> Hysterectomy for non-urgent, benign indication. <h3>Measurements and Main Results</h3> The primary outcome was a composite of any complication or readmission to hospital within 30 days of surgery. Secondary outcomes were ≥ Grade 2 complication, emergency department visit and/or hospital readmission within 30 days of hysterectomy, median operative time and estimated blood loss. Outcomes were evaluated using logistic regression and log-regression linear analysis grouping patients by BMI class (normal, overweight, obesity class 1, 2, and 3) and by hysterectomy route (abdominal, laparoscopic, vaginal). Complications were graded using the Clavien-Dindo Classification. Patient characteristics (age, ASA, pre-operative diagnoses, pre-operative anemia, previous surgeries), surgical factors (intraoperative endometriosis and adhesions, hysterectomy route, uterine weight, concomitant procedures) and surgeon characteristics (volume, training (fellowship-trained/generalist) and hospital (academic/community)) were recorded. Distribution of BMI was: 32.8% (828/2528) normal, 35.1% (889/2528) overweight, 19.8% (500/2528) obesity class 1, 8.1% (205/2528) class 2, and 4.2% (106/2528) class 3. Compared to patients with a normal BMI, obese patients had higher ASA class (p<0.001) and more prior surgeries (p<0.001). Patients with class 2 and 3 obesity were younger (p<0.001), had greater uterine weight (p<0.001) and more adhesions (p<0.001). After controlling for covariates, there was no difference in the odds of developing the primary outcome when all routes of hysterectomy were combined, and when evaluated by route. Regarding secondary outcomes, no differences were noted with the exception of patients with class 2 obesity who underwent vaginal hysterectomies who had 9.1% longer operative time (0.091, 95% CI 0.002-0.18, p<0.05). <h3>Conclusion</h3> BMI class was not independently associated with surgical quality outcomes in patients undergoing hysterectomy for benign, non-urgent indications.