Assessing the Impact of Obesity on Surgical Quality Outcomes Among Women Undergoing Hysterectomy for Benign, Non-Urgent Indications

Study Objective Evaluate impact of obese body mass index (BMI) on surgical quality metrics for patients undergoing hysterectomy for benign, non-urgent indications. Design Multicenter, retrospective review. Setting Seven hospitals in Ontario, Canada (4 academic, 3 community). Patients or Participants 2528 patients undergoing hysterectomy from July 2016 to December 2019. Interventions Hysterectomy for non-urgent, benign indication. Measurements and Main Results The primary outcome was a composite of any complication or readmission to hospital within 30 days of surgery. Secondary outcomes were ≥ Grade 2 complication, emergency department visit and/or hospital readmission within 30 days of hysterectomy, median operative time and estimated blood loss. Outcomes were evaluated using logistic regression and log-regression linear analysis grouping patients by BMI class (normal, overweight, obesity class 1, 2, and 3) and by hysterectomy route (abdominal, laparoscopic, vaginal). Complications were graded using the Clavien-Dindo Classification. Patient characteristics (age, ASA, pre-operative diagnoses, pre-operative anemia, previous surgeries), surgical factors (intraoperative endometriosis and adhesions, hysterectomy route, uterine weight, concomitant procedures) and surgeon characteristics (volume, training (fellowship-trained/generalist) and hospital (academic/community)) were recorded. Distribution of BMI was: 32.8% (828/2528) normal, 35.1% (889/2528) overweight, 19.8% (500/2528) obesity class 1, 8.1% (205/2528) class 2, and 4.2% (106/2528) class 3. Compared to patients with a normal BMI, obese patients had higher ASA class (p Conclusion BMI class was not independently associated with surgical quality outcomes in patients undergoing hysterectomy for benign, non-urgent indications.