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

ObjectiveTo assess the impact of obesity severity on hysterectomy outcomes for uterine hyperplasia/cancer.MethodsThe data from women undergoing hysterectomies for endometrial hyperplasia/uterine cancer with a BMI ≥ 30 kg/m2 were abstracted from records at the University of Virginia and Duke University following IRB approval. Univariate and multivariate statistical analyses were performed.ResultsMean age of the 659 patients was 58.1 yrs; mean body mass index (BMI) was 43 kg/m2. Women were grouped based on BMI: 39.6% (261) were obese (30–39 kg/m2), 41.7% (275) were morbidly obese (40–49 kg/m2) and 18.7% (123) were super obese (≥ 50 kg/m2). Minimally invasive surgical procedures (MIS) were attempted in 280 patients with a conversion rate of 16.1%; BMI was higher in the converted group (47.3 vs. 40.6 kg/m2; p < 0.001). As obesity group increased, there was a decreased frequency of lymphadenectomy (63.8% vs. 37.1% vs. 20.3%; p < 0.001), increased blood loss (242 vs. 281 vs. 378 mL; p < 0.001) and fewer nodes removed (p < 0.001). On multivariate analysis, type of surgery (open vs. MIS) and obesity classification were independently and significantly associated with wound complications (p < 0.001) and the presence of postoperative complications (p < 0.001, p = 0.003). Surgical staging with lymphadenectomy was significantly associated with obesity (p < 0.001) but not procedure type (p = 0.11). Blood transfusion (p < 0.001), hospital readmission (p = 0.025), and ileus (p < 0.001) were significantly associated with open procedures but not obesity. There were no significant differences in progression-free or disease-specific survival based on obesity group.ConclusionWomen with BMI's exceeding 40 kg/m2 have worse surgical outcomes than their less obese counterparts.

► Surgical complications significantly increased as obesity classification increased (BMI ≥ 30 vs. ≥ 40 vs. ≥ 50 kg/m2).
► Performance of lymph node dissection and number of nodes decreased with increasing obesity classification.
► Performance of minimally invasive surgery was associated with decreased complications regardless of obesity classification.