title: Effect of obesity on perioperative outcomes of laparoscopic hysterectomy.
abstract: OBJECTIVE
  To compare the effect of obesity on perioperative outcomes in women undergoing laparoscopic hysterectomy.
  
  
  METHODS
  In this retrospective cohort study, perioperative outcomes of all women who underwent laparoscopic supracervical hysterectomy (LSH) or total laparoscopic hysterectomy (TLH) for benign conditions were compared between obese (body mass index > or = 30 kg/m2) and nonobese women.
  
  
  RESULTS
  Baseline characteristics were similar between 320 (33.0%) obese and 550 (67%) nonobese women except for race and the rates of hypertension and diabetes. The adjusted rates of urinary tract injury, vaginal cuff dehiscence, postoperative fever, and ileus were similar between the groups. For obese women, however, bleeding requiring transfusion was almost 3-fold (3.1 vs. 1.1%, adjusted odds ratio [AOR] 2.93, 95% confidence interval [CI] 1.10-7.80) and laparotomy risk was approximately 2-fold (7.5 vs. 3.5%, AOR 2.35, 95% CI 1.30-4.24) increased. The rate of urinary tract injury was 3.2% when obese women had TLH, but it was 0.3% for LSH performed on nonobese women. Of all 7 cuff dehiscences, 5 (71%) occurred in nonobese women undergoing TLH.
  
  
  CONCLUSIONS
  Obesity increased the risk of bleeding requiring transfusion and conversion to laparotomy but did not influence the other perioperative complications. On subgroup analysis, LSH in nonobese women seems to result in best outcomes.
authors.affiliation: Department of Obstetrics and Gynecology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA 01199, USA. oz.harmanli@bhs.org
authors.forename: Oz
authors.initials: O
authors.lastname: Harmanli
authors.affiliation: Department of Obstetrics and Gynecology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA 01199, USA.
authors.forename: Sertac
authors.initials: S
authors.lastname: Esin
authors.affiliation: Department of Obstetrics and Gynecology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA 01199, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Knee
authors.affiliation: Department of Obstetrics and Gynecology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA 01199, USA.
authors.forename: Keisha
authors.initials: K
authors.lastname: Jones
authors.affiliation: Department of Obstetrics and Gynecology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA 01199, USA.
authors.forename: Reyhan
authors.initials: R
authors.lastname: Ayaz
authors.affiliation: Department of Obstetrics and Gynecology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA 01199, USA.
authors.forename: Elena
authors.initials: E
authors.lastname: Tunitsky
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007431:Intraoperative Complications / Q000453:epidemiology*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014551:Urinary Tract / Q000293:injuries