Effect of extreme obesity on outcomes in laparoscopic hysterectomy.
OBJECTIVE
To estimate the effect of body mass index (BMI) on several outcomes in laparoscopic hysterectomy, in particular in the extremes of obesity.


METHODS
Retrospective cohort study (Canadian Task Force classification II-3).


METHODS
Tertiary-care university-based teaching hospital.


METHODS
Eight hundred thirty-four patients who underwent laparoscopic hysterectomy from January 2007 to October 2011.


METHODS
Laparoscopic hysterectomy for benign indications.


RESULTS
Demographic, operative, and postoperative data were abstracted from medical records. The primary outcome was a composite index score that took into account operative time, nonsurgical operating room time, estimated blood loss, length of hospital stay, number of complications, and severity of complications according to the Dindo-Clavien classification. We individually examined elements of the composite index as a secondary outcome. Models were developed to assess the association of BMI with the composite index score and the components of the index, controlling for age, presence of diabetes, tobacco use, surgeon, type of hysterectomy (total vs supracervical), use of robotics, uterine weight, number of additional procedures performed, presence of adhesions requiring lysis, and deeply infiltrating endometriosis as potential confounders. Mean (SD) BMI was 31.4 (8.1). Mean (SD) uterine weight was 345 (388) g. Mean operative time was 150 (61) minutes. Increasing BMI was associated with a worse composite score (p < .01); longer operative time (p = .03), nonsurgical operating room time (p = .02), and total operating room time (p < .01); greater estimated blood loss (p < .01); and complication severity (p = .01).


CONCLUSIONS
These data suggest that there is a significant association of BMI with surgical outcomes in laparoscopic hysterectomy, and the effect is most pronounced in the morbidly obese. These patients may stand to gain the greatest differential benefit from a laparoscopic approach to surgery. However, they should be properly counseled about the challenge that obesity poses to the operation.
Department of Obstetrics and Gynecology, Division of Advanced Laparoscopy and Pelvic Pain, University of North Carolina, Chapel Hill, USA. matthew_siedhoff@med.unc.edu
Matthew T
MT
Siedhoff
Erin T
ET
Carey
Austin D
AD
Findley
Lauren E
LE
Riggins
Joanne M
JM
Garrett
John F
JF
Steege
D000328:Adult; D016063:Blood Loss, Surgical; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007431:Intraoperative Complications / Q000209:etiology; D010535:Laparoscopy; D007902:Length of Stay; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D009873:Operating Rooms; D061646:Operative Time; D009929:Organ Size; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014599:Uterus / Q000473:pathology*