Beyond mere obesity: effect of increasing obesity classifications on hysterectomy outcomes for uterine cancer/hyperplasia

Abstract

Objective: To assess the impact of obesity severity on hysterectomy outcomes for uterine hyperplasia/cancer.

Methods: The data from women undergoing hysterectomies for endometrial hyperplasia/uterine cancer with a BMI≥30 kg/m(2) were abstracted from records at the University of Virginia and Duke University following IRB approval. Univariate and multivariate statistical analyses were performed.

Results: Mean age of the 659 patients was 58.1 yrs; mean body mass index (BMI) was 43 kg/m(2). Women were grouped based on BMI: 39.6% (261) were obese (30-39 kg/m(2)), 41.7% (275) were morbidly obese (40-49 kg/m(2)) and 18.7% (123) were super obese (≥50 kg/m(2)). Minimally invasive surgical procedures (MIS) were attempted in 280 patients with a conversion rate of 16.1%; BMI was higher in the converted group (47.3 vs. 40.6 kg/m(2); p<0.001). As obesity group increased, there was a decreased frequency of lymphadenectomy (63.8% vs. 37.1% vs. 20.3%; p<0.001), increased blood loss (242 vs. 281 vs. 378 mL; p<0.001) and fewer nodes removed (p<0.001). On multivariate analysis, type of surgery (open vs. MIS) and obesity classification were independently and significantly associated with wound complications (p<0.001) and the presence of postoperative complications (p<0.001, p=0.003). Surgical staging with lymphadenectomy was significantly associated with obesity (p<0.001) but not procedure type (p=0.11). Blood transfusion (p<0.001), hospital readmission (p=0.025), and ileus (p<0.001) were significantly associated with open procedures but not obesity. There were no significant differences in progression-free or disease-specific survival based on obesity group.

Conclusion: Women with BMI's exceeding 40 kg/m(2) have worse surgical outcomes than their less obese counterparts.