School of Medicine and Health Sciences Poster Presentations

Poster Number

293

Document Type

Poster

Status

Medical Student

Abstract Category

Obesity

Keywords

hysterectomy, obesity, BMI, postoperative, complications

Publication Date

Spring 2018

Abstract

Background: The prevalence of obesity in American women is 38.3%. Hysterectomy is the second most common surgery in reproductive age women; most of these procedures are performed laparoscopically. From 2011 to 2015, 3.2% of women age 15-44 years underwent hysterectomy; 89.6% of these procedures were performed for management of medical conditions including uterine fibroids, menstrual disorders, uterine prolapse, and endometriosis. The high rates of obesity and hysterectomy in women demand better understanding of the relationship between obesity and postoperative complications following laparoscopic hysterectomy. Methods: We conducted a retrospective cohort study using the American College of Surgeons National Quality Improvement Database (ACS-NSQIP) by identifying all patients who underwent laparoscopic total hysterectomy, laparoscopic assisted vaginal hysterectomy, or laparoscopic supracervical hysterectomy from 2007 to 2013 using Current Procedural Terminology (CPT) codes. These patients were stratified by BMI (40); univariate and multivariate analyses were then performed to evaluate the incidence of postoperative complications in these groups. Results: Patients with BMI > 30 were more likely to experience postoperative complications including superficial surgical site wound infection, deep surgical site infection, failure to wean from the ventilator > 48 hours, unplanned reintubation, deep vein thrombosis, pulmonary embolism, urinary tract infection, renal insufficiency, renal failure, and extended hospital length of stay > 2 days. Multivariate analysis suggests that BMI > 30 is an independent risk factor for superficial surgical site infection, deep vein thrombosis, and pulmonary embolism. Conclusion: Patients with obesity and morbid obesity were more likely to present with risk factors and comorbidities than nonobese patients. While complication rates following laparoscopic hysterectomy are low across BMI groups, patients with BMI > 30 were more likely to suffer from at least one postoperative complication. Data indicate that obesity may contribute to a significantly increased risk of deep vein thrombosis and pulmonary embolism in the postoperative period, suggesting the need for additional venous thromboembolism prophylaxis. Obesity should be considered when planning for and performing laparoscopic hysterectomy.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Open Access

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Comments

Presented at GW Annual Research Days 2018.

Available for download on Saturday, October 13, 2018

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Morbid obesity is associated with postoperative complications in laparoscopic hysterectomy

Background: The prevalence of obesity in American women is 38.3%. Hysterectomy is the second most common surgery in reproductive age women; most of these procedures are performed laparoscopically. From 2011 to 2015, 3.2% of women age 15-44 years underwent hysterectomy; 89.6% of these procedures were performed for management of medical conditions including uterine fibroids, menstrual disorders, uterine prolapse, and endometriosis. The high rates of obesity and hysterectomy in women demand better understanding of the relationship between obesity and postoperative complications following laparoscopic hysterectomy. Methods: We conducted a retrospective cohort study using the American College of Surgeons National Quality Improvement Database (ACS-NSQIP) by identifying all patients who underwent laparoscopic total hysterectomy, laparoscopic assisted vaginal hysterectomy, or laparoscopic supracervical hysterectomy from 2007 to 2013 using Current Procedural Terminology (CPT) codes. These patients were stratified by BMI (40); univariate and multivariate analyses were then performed to evaluate the incidence of postoperative complications in these groups. Results: Patients with BMI > 30 were more likely to experience postoperative complications including superficial surgical site wound infection, deep surgical site infection, failure to wean from the ventilator > 48 hours, unplanned reintubation, deep vein thrombosis, pulmonary embolism, urinary tract infection, renal insufficiency, renal failure, and extended hospital length of stay > 2 days. Multivariate analysis suggests that BMI > 30 is an independent risk factor for superficial surgical site infection, deep vein thrombosis, and pulmonary embolism. Conclusion: Patients with obesity and morbid obesity were more likely to present with risk factors and comorbidities than nonobese patients. While complication rates following laparoscopic hysterectomy are low across BMI groups, patients with BMI > 30 were more likely to suffer from at least one postoperative complication. Data indicate that obesity may contribute to a significantly increased risk of deep vein thrombosis and pulmonary embolism in the postoperative period, suggesting the need for additional venous thromboembolism prophylaxis. Obesity should be considered when planning for and performing laparoscopic hysterectomy.