Outcomes of Benign Hysterectomy for Patients with Severe Obesity

Abstract

<h3>Study Objective</h3> To compare benign hysterectomy outcomes by approach in patients with body mass index (BMI) ≥ 40 kg/m ². <h3>Design</h3> Retrospective cohort (Canadian Task Force Classification II-2). <h3>Setting</h3> Data from the American College of Surgeons National Surgical Quality Improvement Program from 2015-2019. <h3>Patients or Participants</h3> Women with BMI ≥ 40 kg/m ² undergoing laparoscopic (LH) or abdominal hysterectomy (AH) for benign conditions were identified by CPT code. <h3>Interventions</h3> Preoperative variables and surgical outcomes were evaluated. <h3>Measurements and Main Results</h3> 9610 women with BMI ≥ 40 kg/m ² were identified, of which 78.4% underwent LH and 21.6% underwent AH. White women underwent LH more frequently than Black women (86.6% vs. 65.5%, p>.0001). Over the study period, LH increased (65.6% to 96.3%, p>.0001) and AH decreased (34.4% to 3.7%, p>.0001). The mean uterine weight for AH versus LH was 613.2 ± 808.8, and 212.1 ± 247.1. LH was performed for uterine weight <250g most frequently (86.6%), while for uteri 250-499g the rate decreased to 74.7% and for >500g the rate was 38.9% (p<.0001). The adjusted OR for LH >500g was 0.1 aOR(95% CI [0.1-0.2], p=<.0001). The adjusted odds of wound complications, bleeding/transfusion, and readmission was higher with AH. However, the odds of operative time > 90 minutes was higher with LH. <h3>Conclusion</h3> Women with BMI ≥ 40 kg/m ² are at higher risk of complications with surgery. The rate of LH for these women is lower than women with lower BMI. Uterine weight is the strongest predictor of AH in these women. The odds of complications is lower with LH, even at high uterine weights. Black women with BMI ≥ 40 kg/m ² have lower rates of LH compared to White women.