National trends and outcomes of morbidly obese women who underwent inpatient hysterectomy for benign gynecological disease in the USA

Abstract

The US population has witnessed an epidemic expansion of obesity in the past several decades; nearly 50% of the population is projected to be obese by 2030 and 25% morbidly obese. This study examined trends, characteristics and outcomes of morbidly obese women who underwent benign hysterectomy. This is a population-based retrospective observational study querying the National Inpatient Sample from January 2012 to September 2015. The study population included 509395 women who underwent hysterectomy for benign gynecological disease: 430865 (84.6%) non-obese women, 50435 (9.9%) women with class I-II obesity and 28095 (5.5%) women with class III obesity. Main outcome measures were (i) cohort-level trends of obesity and perioperative complications assessed by piecewise linear regression with log transformation and (ii) patient-level perioperative complication risk by body habitus assessed with a generalized estimating equation after using a multiple-group generalized boosted model. The rate of class III obesity increased by 40.4%, higher than the rate of class I-II obesity (22.2%) (both, P<.001). In parallel, cohort-level rates of perioperative complication and prolonged hospitalization for ≥7days increased by 19.4% and 54%, respectively (P<.001). In a weighted model, class I-II obesity (16.4% vs 14.6%, odds ratio 1.15, 95% confidence interval 1.08-1.21) and class III obesity (19.2% vs 14.6%, odds ratio 1.39, 95% confidence interval 1.28-1.51) had a significantly increased risk of perioperative complications compared with non-obesity. Larger body habitus was associated with higher total charge (median, $35180, $36094 and $39382; all values cited in US dollars) and prolonged admission rate for ≥7days (2.9%, 3.1% and 3.9%) (both, P<.001). The rate of obesity, particularly morbid obesity, has significantly increased among women undergoing benign hysterectomy in the USA. Morbidly obese women had adverse perioperative outcomes, and the increasing number of morbidly obese women resulted in both an increased perioperative morbidity and total charges as a cohort. National and society-based approaches are necessary to reduce the obesity rate and hysterectomy morbidity.