(Poster 139) BMI and Perioperative Outcomes for Hysterectomy with POP: A NSQIP Analysis

Objectives: To determine if obesity, measured as body mass index (BMI) > 30 mg/k^2, is associated with 30-day perioperative morbidity following hysterectomy with concomitant POP surgery using the American College of Surgeons National Surgical Quality Improvement Project (NSQIP) database.

Methods: We conducted a retrospective cohort of women undergoing hysterectomy for POP surgery from 2014 to 2023. The independent variable, BMI, was stratified into normal/overweight (BMI=19-30mg/k^2), obesity I/II (BMI=30-40mg/k^2), and obesity III (BMI=40-57mg/k^2). The primary outcome was a composite variable of major complications within 30 days of hysterectomy (i.e. thromboembolic event). Secondary outcomes included minor complications, hysterectomy complications (i.e. ureteral or bladder injury), length of stay (LOS), and operative time. Logistic and lognormal regressions were conducted for the primary and secondary outcomes.

Results: A total of 30,701 individuals were included in this analysis. Mean age was 58±12 years and 71% of women were White. Overall, 64.8% were normal/overweight, 30.6% were obesity classes I/II, and 4.51% were obesity class III. Obesity class III women were more likely to be younger, African American/Black, active smokers, diabetic, hypertensive, and ASA class 3 or 4 (all p< 0.001). They were more likely to have endometriosis, pelvic inflammatory disease (PID), prior abdominal and pelvic surgeries, (all p< 0.001). They were less likely than normal/overweight women to have their hysterectomy performed by a urogynecologist, and more likely to have their surgery performed by a gyn oncologist or general OB/GYN (p < 0.001). They were more likely to have an LAVH or TLH compared to a vaginal hysterectomy. Finally, they were more likely to have a hysterectomy alone than with other procedures (Figure 1). In univariable analyses of our primary outcome, there was a small increased risk of major complication in obesity class III women (3.3%) compared to obesity class I/II (3.1%) and normal/overweight women (2.7%) (p=0.0453). There was also an increased risk of minor complications, operative time, and LOS. There was no difference in the risk of hysterectomy specific complications. In the adjusted regression model, we found the risk of a major complication was not increased in obese classes I/II and obese class III women (Figure 2). We found that younger age, American Indian/Alaskan race, ASA 3 or 4, history of prior abdominal surgery and hysterectomy performed by a gynecologic oncologist increased the risk of a major complications. There were no associations with BMI and minor complications in the multivariable analyses. The only factor associated with hysterectomy complications included having a gynecologic oncologist as the surgeon (aOR 2.72 95% CI 1.58-4.45]). Finally, obese I/II and III women had longer operation times and LOS in the adjusted models.

Conclusions: Obesity was not independently associated with an increased risk of complications within 30 days of hysterectomy performed for POP.