title: Impact of body mass index and operative approach on surgical morbidity and costs in women with endometrial carcinoma and hyperplasia.
abstract: To assess the impact of body mass index (BMI) and operative approach on surgical morbidity and costs in patients with endometrial carcinoma (EC) and hyperplasia (EH).
  
  
  
  All women with BMI data who underwent surgery for EC or EH from 2008 to 2014 were identified from MarketScan, a healthcare claims database. Differences in 30-day complications and costs were compared between BMI groups and stratified by surgical modality.
  
  
  
  Of 1112 patients, 35%, 36%, and 29% had a BMI of ≤29, 30-39, and ≥40kg/m2, respectively. Compared to patients with a BMI of 30-39 and ≤29, women with a BMI ≥40 had higher rates of venous thromboembolism (3% vs 0.2% vs 0.3%, p<0.01) and wound infection (7% vs 3% vs 3%, p=0.02). This increase was driven by the subset of patients who had laparotomy and was not seen in those undergoing minimally invasive surgery (MIS). Median total costs for women with a BMI ≥40, 30-39, and ≤29 were U.S. $17.3k, $16.8k, and $16.6k respectively (p=0.53). Costs were higher for patients who had laparotomy than those who had MIS across all BMI groups, with the cost difference being highest in morbidly obese women (≥40: $21.6k vs $14.9k, p<0.01; 30-39: $18.9k vs $16.1k, p=0.01; ≤29: $19.3k vs $15k, p<0.01). Patients who had complications had higher costs compared to those who did not, with a higher cost difference in the laparotomy group ($27.7k vs $16.4k, p<0.01) compared to the MIS group ($19.9k vs $15k, p<0.01).
  
  
  
  MIS may increase the value of care by minimizing complications and decreasing costs. This may be most pronounced in morbidly obese women.
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
authors.forename: Rudy S
authors.initials: RS
authors.lastname: Suidan
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
authors.forename: Weiguo
authors.initials: W
authors.lastname: He
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
authors.forename: Charlotte C
authors.initials: CC
authors.lastname: Sun
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhao
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
authors.forename: Nicole D
authors.initials: ND
authors.lastname: Fleming
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
authors.forename: Pedro T
authors.initials: PT
authors.lastname: Ramirez
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
authors.forename: Pamela T
authors.initials: PT
authors.lastname: Soliman
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
authors.forename: Shannon N
authors.initials: SN
authors.lastname: Westin
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
authors.forename: Karen H
authors.initials: KH
authors.lastname: Lu
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
authors.forename: Sharon H
authors.initials: SH
authors.lastname: Giordano
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States. Electronic address: lmeyer@mdanderson.org.
authors.forename: Larissa A
authors.initials: LA
authors.lastname: Meyer
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002277:Carcinoma / Q000453:epidemiology / Q000601:surgery*; D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D004714:Endometrial Hyperplasia / Q000453:epidemiology / Q000601:surgery*; D016889:Endometrial Neoplasms / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000191:economics / Q000379:methods*; D007045:Hysterectomy, Vaginal / Q000191:economics / Q000379:methods; D010535:Laparoscopy / Q000191:economics; D007813:Laparotomy / Q000191:economics; D008197:Lymph Node Excision / Q000191:economics; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics; D009765:Obesity / Q000191:economics / Q000453:epidemiology; D009767:Obesity, Morbid / Q000191:economics / Q000453:epidemiology*; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000191:economics; D013530:Surgical Wound Infection / Q000191:economics / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000191:economics / Q000453:epidemiology*
keywords: Body mass index; Complications; Cost; Endometrial cancer; Endometrial hyperplasia; Minimally invasive surgery