The Effect of Bariatric Surgery on Post-Operative Outcomes After Hysterectomy [6D

Abstract

INTRODUCTION: Bariatric surgery is common and has been associated with an improvement in obesity-related medical co-morbidities. However, outcomes after hysterectomy for women who have had bariatric surgery is unknown. Our objective was to compare post-hysterectomy outcomes between patients who had bariatric surgery before hysterectomy and obese patients without prior bariatric surgery. METHODS: We performed an IRB-approved study of patients who had hysterectomy by any route between 1/2000 and 3/2018 at a large academic medical center. Patients with malignancy were excluded. Multivariable logistic regression was used for analysis. RESULTS: 223 patients with bariatric surgery before hysterectomy were compared to 225 patients with body mass index (BMI) >40 kg/m2 and no previous bariatric surgery. The average BMI in the bariatric surgery group was 35 kg/m2, compared to 46 kg/m2 in the no bariatric surgery group. We observed a lower proportion of patients with diabetes, hypertension, and hyperlipidemia in the bariatric surgery group compared to the no bariatric surgery group. We found no significant difference in the odds of intraoperative (visceral injury, blood transfusion, conversion to laparotomy) or postoperative complications including major complications (transfusion, cuff dehiscence, surgical site complication, venous thromboembolism, bowel obstruction), minor complications, re-hospitalization, and re-operation within 30 days of hysterectomy, even after adjusting for confounding factors between groups. CONCLUSION: Despite a significantly higher BMI and higher proportion of obesity-related co-morbidities, there was no difference in the odds of intraoperative or postoperative complications after hysterectomy in morbidly obese women, compared to women with a history of bariatric surgery prior to hysterectomy.