The Impact of Body Mass Index on Surgical Complications in Minimally Invasive Hysterectomy for Adenomyosis

Abstract

Study Objective

To determine the impact of BMI on 30-day postoperative complications for patients undergoing minimally invasive hysterectomy (MIH) for adenomyosis in the United States.

Design

A cohort study of prospectively collected data.

Setting

American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2012 – 2020.

Patients or Participants

Patients with adenomyosis undergoing MIH.

Interventions

Minimally invasive hysterectomy.

Measurements and Main Results

Patients who underwent MIH for adenomyosis were classified into BMI subgroups based on the WHO classification system. Postoperative minor and major complications occurring within 30 days, defined according to the Clavien-Dindo classification, were compared across the BMI subgroups.

A total of 14,879 patients were included in the cohort. Higher BMI classes were associated with longer operative times (range 110.5-135.6 minutes, p<0.001).

The overall rate of complications ranged 7.1%-10.9% between groups, with the highest in the underweight group. There was a significant difference in the rates of any and major complications between groups (p=0.006 and p=0.020 respectively). When analyzing specific complications, higher BMI was associated with increased risk of superficial surgical site infection (p<0.001). Risks of septic shock or death were highest in the obesity class 3 group, but remained low (0.2% for both complications in obesity class 3).

In multivariable regression analysis comparing low and high BMI groups (</≥BMI 37.6), higher BMI was associated with increased odds for major complications [aOR 95% CI =1.29 (1.01-1.66)]. There was no significant association between low and high BMI and minor complications.

In multivariable regression analysis comparing BMI subgroups, BMI categories were not independently associated with any, minor, or major complications compared to the normal BMI category.

Conclusion

After adjusting for confounding factors, BMI ≥37.6 is independently associated with increased risk of major complications, but not with minor complications. Stratification by BMI groups did not reveal increased risk groups. These findings are reassuring and can help counsel and prepare patients for surgery.