Association between Obesity and Surgical Outcomes for Minimally Invasive Hysterectomy

Abstract

Study Objective To investigate the morbidity associated with minimal invasive hysterectomy in obese women. Design This is a retrospective cohort study. The National Surgical Quality Improvement Project database from 2014 to 2017 was queried for all women who underwent laparoscopic, robotic or vaginal hysterectomy. Our primary outcome was the composite morbidity (including surgical site infection, pulmonary, sepsis, thromboembolic, cardiac and renal complications). Our secondary outcomes included length of stay, readmission, reoperation and surgical complications. A multivariable logistic regression adjusting for Age, Race, ASA, smoking, surgical approach and operation time was performed. Setting Hospitals participating in the program. Patients or Participants Patients undergoing minimally invasive hysterectomy for benign disease excluding urogynecologic, cancer or additional procedures. Interventions N/A Measurements and Main Results 39,368 (36.8%) hysterectomies were analyzed including 18,767 (47.8%) obese and 20,501 (52.2%) non-obese women. Obesity was associated with increased risk for the primary outcome compared to nonobese women (2.9% vs 2.2%, aOR 1.27, 95% CI 1.12-1.45). When assessing the different components of the primary outcome, obesity was associated with increased risk for superficial site infection compared to nonobese women (1.0% vs. 0.6%, aOR 1.63, 95% CI 1.29-2.06) and there was no difference in the risk of the other surgical morbidity. Obesity was associated with increased risk for length of stay > 2 days (2.8% vs 2.4%, p Conclusion The rate of surgical morbidity in obese women undergoing minimally invasive hysterectomy is low but remains significantly higher than that of nonobese women. It is mainly driven by the superficial wound infection rate. Future interventions such as specific wound care interventions in obese patients could be explored to minimize that risk.