Effect of BMI on Outcomes after Surgery for Apical Pelvic Organ Prolapse

Abstract

<h3>Study Objective</h3> Evaluate the impact of obesity on outcomes after apical pelvic organ prolapse surgery. <h3>Design</h3> Retrospective cohort study using cases identified in the ACS-NSQIP database from 2014-2018. <h3>Setting</h3> Surgical cases from 722 hospitals nationally. <h3>Patients or Participants</h3> 26,898 females age 18-89 who underwent apical prolapse repair were identified by CPT codes. BMI categories are defined as: underweight (BMI <18.5, N=147), normal weight (BMI 18.5-24.9, N=7,374), overweight (BMI 25.0-29.9, N=10,268), class 1 obesity (BMI 30.0-34.9, N=5,810), class 2 obesity (BMI 35.0-39.9, N=2,240), and class 3 obesity (BMI ≥ 40.0, N=1,059). <h3>Interventions</h3> Participants underwent vaginal colpopexy (N=15,466), laparoscopic or robotic sacral colpopexy (N= 9,678), or abdominal sacrocolpopexy (N=1,754). <h3>Measurements and Main Results</h3> The average age of the cohort was 60 years, with 76.3% identifying as white race, 24.2% ASA class 3 or 4, 44.5% with a major medical comorbidity, and 9.0% smoking within one year. A total of 1,463 patients (5.4%) experienced a minor complication, 611 (2.3%) a major complication, and 1,993 (7.4%) any complication. Complication rates differed significantly by BMI class (minor p=0.005, major p<.001, any p<.001). Class 3 obesity had higher rates of any complication and minor complication compared to all classes except underweight and more major complication compared to normal, overweight and class 1 obesity. After adjusting for age, race, ASA class, smoking, and repair type, significant associations persisted between BMI and complications. <h3>Conclusion</h3> Based on national data from over 26,000 apical prolapse procedures, obesity is associated with post-operative complications. As obesity and average BMI in the US continue to increase, controlled studies are needed to confirm these findings. These results should be considered in preoperative planning and patient counseling.