title: Influence of the modifiable life-style factors body mass index and smoking on the outcome of hysterectomy.
abstract: BACKGROUND
  The aim of this study was to study the impact of body mass index (BMI) and smoking on the outcome of hysterectomy and whether effects of these factors vary between abdominal, laparoscopic and vaginal hysterectomy.
  
  
  METHODS
  Pre-, per- and postoperative (8 weeks) data were retrieved from the Swedish National Register for Gynecological Surgery on 28 537 hysterectomies performed because of a benign indication between 2004 and 2013. Multivariable logistic regression analyses were used to identify independent factors affecting the rate of complications, presented as adjusted odds ratios (adjOR) with 95% confidence intervals (CI).
  
  
  RESULTS
  Overweight and obesity had the strongest impact on complications in the abdominal hysterectomy group. In women with a BMI ≥ 30 an increased adjOR could be seen for bleeding >1000 mL (2.90; 95% CI 2.23-3.77), peroperative complications (1.54; 95% CI 1.26-1.88), operation time >120 min (2.67; 95% CI 2.33-3.03), postoperative complications (1.21; 95% CI 1.08-1.34) and postoperative infections (1.73; 95% CI 1.50-1.99). With vaginal hysterectomy, the effect of BMI ≥ 30 could be seen in relation to excessive bleeding >500 mL (1.63; 95% CI 1.22-2.17) and operative time >120 min (2.00; 95% CI 1.60-2.50). With laparoscopic hysterectomy (LH), a BMI ≥ 30 had a higher adjOR for prolonged surgery (1.71; 95% CI 1.30-2.26). Smokers had an increased risk of postoperative infection in the abdominal hysterectomy (1.23; 95% CI 1.07-1.40) and vaginal hysterectomy groups (1.21; 95% CI 1.02-1.43) but not in the LH group.
  
  
  CONCLUSIONS
  Body mass index and smoking had a negative effect with all hysterectomy approaches but to a lesser extent in vaginal and laparoscopic hysterectomies. This should be taken into consideration in advance of surgery to improve outcome.
authors.affiliation: Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
authors.forename: Katja S
authors.identifier: http://orcid.org/0000-0002-9064-8454
authors.initials: KS
authors.lastname: Bohlin
authors.affiliation: Department of Gynecology, Halmstad Hospital, Halmstad, Sweden.
authors.forename: Maud
authors.identifier: http://orcid.org/0000-0003-2476-3435
authors.initials: M
authors.lastname: Ankardal
authors.affiliation: Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
authors.forename: Jan-Henrik
authors.identifier: http://orcid.org/0000-0002-3846-6071
authors.initials: JH
authors.lastname: Stjerndahl
authors.affiliation: Department of Mathematics and Mathematical Statistics, Umeå University, Umeå, Sweden.
authors.forename: Håkan
authors.identifier: http://orcid.org/0000-0002-9493-0959
authors.initials: H
authors.lastname: Lindkvist
authors.affiliation: Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
authors.forename: Ian
authors.identifier: http://orcid.org/0000-0002-0400-5509
authors.initials: I
authors.lastname: Milsom
mesh_terms: D000005:Abdomen / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods; D007239:Infections / Q000453:epidemiology*; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000453:epidemiology*; D061646:Operative Time; D050177:Overweight / Q000150:complications / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D012042:Registries; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
keywords: Abdominal hysterectomy; body mass index; complications; laparoscopic hysterectomy; smoking; vaginal hysterectomy