Body mass and risk of complications after hysterectomy on benign indications

Abstract

In this cohort study, we included data on health and lifestyle collected prospectively for all hysterectomy referrals for benign indications in Denmark from 2004 to 2009. Logistic regression was used to investigate relationship between BMI and complications reported at surgery or during the first 30 days after surgery. RESULTS; Of the 20 353 women with complete data, 6.0% had a BMI < 20 kg/m(2), 31.9% with BMI between 25 and 30 kg/m(2) (classified as overweight) and 17.5% with a BMI ≥ 30 kg/m(2) (categorized as obese). The overall rate of complications was 17.6%, with bleeding being the most common specific complication (6.8%). After adjustment for age, ethnicity, education, indication for surgery, uterus weight, use of prophylaxis, American Society of Anaesthesiologists classification, co-morbidity status and route of hysterectomy, obesity was associated with an increased risk of heavy bleeding during surgery [odds ratio (OR) = 3.64 (2.90-4.56)], all bleeding complications [OR = 1.27 (1.08-1.48)] and infection [OR = 1.47 (1.23-1.77)]. The risk of all bleeding complications [OR = 1.48 (1.28-1.82)] and re-operation [OR = 1.66 (1.26-2.17)] were also increased among women with a BMI < 20. This U-shaped relation between BMI and bleeding, and the association between high BMI and infections were only seen for the abdominal route [abdominal hysterectomy (AH)]. The risk of infections was elevated among women with BMI<20 who underwent laparoscopic surgery [laparoscopic hysterectomy (LH)]. CONCLUSIONS; Obesity increases the risks of bleeding and infections after AH. A BMI below 20 seems to increase the risks of bleeding and infection after AH and LH, respectively.

Beyond mere obesity: Effect of increasing obesity classifications on hysterectomy outcomes for uterine cancer/hyperplasia

“…Studies evaluating the effect of BMI on hysterectomy outcomes have shown higher perioperative blood loss [3][4][5][6][7], increased infection [8], Gynecologic Oncology 127 (2012) 326-331 ☆ This research was presented during an oral plenary session at…”

Does obesity complicate perioperative course in patients undergoing abdominal hysterectomy?

“…Even more compelling is the paper by Santoso et al [14] demonstrating analogous outcome profile in obese patients undergoing endometrial cancer staging, an arguably more extensive procedure. Although a large Danish cohort study suggested that obesity is associated with a higher risk of infectious and all bleeding complications after abdominal hysterectomy increase in the risk of the latter was also found in women with BMI lower than 20 kg/m 2 [15].…”

Laparoscopic supracervical hysterectomy: impact of body mass index and uterine weight

“…The increasing prevalence of obesity with associated fibroids uterus and menstrual problems the world over is such that the practicing gynecologist would expect more patients from this group attending for hysterectomy [16]. Originally, obesity was considered as a relative contraindication for laparoscopic surgery, but with improved technology and skills, the current evidence suggests that laparoscopic hysterectomy is feasible and safe in obese women; however, it is associated with relatively more operative time and risk of bleeding [12,[17][18][19].…”

“…Obesity is an increasing problem and is a risk factor for the development of uterine fibroids and dysfunctional uterine bleeding which may require hysterectomy [3]. Obesity increases the risks of bleeding and infection after abdominal as well as vaginal hysterectomy [4].…”