Effect of body mass index on maternal morbidity following peripartum hysterectomy

Abstract

The objective of this study was to estimate the impact of maternal body mass index (BMI) on maternal morbidity following unscheduled peripartum hysterectomy. A retrospective cohort study of consecutive peripartum hysterectomies at our institution from 1988 through 2012; scheduled hysterectomies were excluded. Medical records were reviewed and maternal, foetal and surgical data collected for each subject. Maternal BMI was categorized by the National Institute of Health classifications for overweight and obese. Statistical analyses included evaluation for trend. A total of 360,774 women delivered at Parkland Hospital during the study period with 665 (1.8 per 1000 deliveries) unscheduled peripartum hysterectomies performed. BMI was available for 635 women. Gestational diabetes, chronic hypertension and pregnancy-related hypertension were significantly higher in all three obesity categories, P = < 0.01. Post-partum complications, such as venous thrombosis and composite surgical morbidity did not differ among BMI groups. Estimated blood loss and units transfused did not differ across the BMI categories, P = 0.42 and P = 0.38, respectively. Increasing BMI was associated with longer surgical times and more wound infections, P = 0.01. These complications should be considered when approaching a peripartum hysterectomy in patients with obesity.

The association between race/ethnicity and peripartum hysterectomy and the risk of perioperative complications

“…First, the NIS dataset is limited by the accuracy of diagnosis and procedural coding. For example, obesity, a risk factor for adverse maternal outcomes, 45 is frequently under‐coded in claims data 46 . Additionally, within the present dataset, it was not possible to ascertain the temporality of outcomes relative to the peripartum hysterectomy.…”

“…First, the NIS dataset is limited by the accuracy of diagnosis and procedural coding. For example, obesity, a risk factor for adverse maternal outcomes, 45 is frequently under-coded in claims data. 46 Additionally, within the present dataset, and race and is recommended to be collected via self-report, these data from hospital administrative systems consist of some combination of self-reported and observed information.…”

Increasing Pre-Pregnancy Body Mass Index and Pregnancy Outcomes in the United States: Analysis of the US Vital Statistics Records (2015-2019)

“…There was no difference between BMI groups in postpartum complications such as venous thrombosis and composite surgical morbidity (25). Additionally, increasing BMI was associated with longer surgical times and wound infections (25).…”

“…While research on an unplanned hysterectomy in relation to BMI is not readily available, studies have shown that among women who had a hysterectomy, obesity increases the risk of complications (24). According to a study, unscheduled peripartum hysterectomies were more likely among women with comorbidities such as gestational diabetes, chronic hypertension, and pregnancy-related hypertension (25). There was no difference between BMI groups in postpartum complications such as venous thrombosis and composite surgical morbidity (25).…”

“…According to a study, unscheduled peripartum hysterectomies were more likely among women with comorbidities such as gestational diabetes, chronic hypertension, and pregnancy-related hypertension (25). There was no difference between BMI groups in postpartum complications such as venous thrombosis and composite surgical morbidity (25). Additionally, increasing BMI was associated with longer surgical times and wound infections (25).…”