CHARLESTON, S.C. – Obese women are at greater risk of complications from hysterectomy than are nonobese women, but the difference is primarily related to minor complications, according to findings from a large retrospective cohort study.
Of 907 women who underwent hysterectomy at a single center between July 2006 and January 2009, 267 (29%) were obese. Overall, 154 of the patients had at least one complication. After the investigators adjusted for race, prior cesarean section, malignancy, concomitant procedures, and previous surgeries, the obese women were found to be significantly more likely than the nonobese women to experience any complication (adjusted odds ratio, 1.62), Dr. Kristen A. Matteson reported at the annual meeting of the Society of Gynecologic Surgeons.
Dr. Kristen A. Matteson
However, this was secondary to an increased odds of minor complications (adjusted OR, 1.69), not major complications (adjusted OR, 1.06), according to Dr. Matteson of the Women and Infants Hospital of Rhode Island and Brown University, both in Providence, R.I.
In the 142 obese women in the study who underwent hysterectomy for benign indications, but had no concomitant procedures, the minor complication rate was greatest with abdominal hysterectomy (23.3%), followed by laparoscopic hysterectomy (12.6%). No complications occurred in those who underwent vaginal hysterectomy, but the differences between the groups with respect to minor complications were not statistically significant.
"No difference was seen in major complication rates in this subgroup," Dr. Matteson said at the meeting, which was jointly sponsored by the American College of Surgeons.
Patients included in the study were all those who underwent laparoscopic hysterectomy at the Women and Infants Hospital during the study period, as well as a random subset of women who underwent abdominal and vaginal hysterectomies, who were selected as comparators. Obesity was determined based on body mass index and according to World Health Organization guidelines.
Minor complications included conversion to laparotomy, wound cellulitis, need for transfusion, prolonged surgery, and length of hospitalization above the 90th percentile. Major complications included bowel injury, blood vessel injury, trocar site hernia, pelvic hematoma, vaginal nonhealing, need for reoperation, pelvic infection, urinary tract infection, sepsis, and thromboembolic event.
The findings are important given that approximately 600,000 hysterectomies are performed in the United States each year, according to the Centers for Disease Control and Prevention, and given that the prevalence of obesity is skyrocketing, Dr. Matteson said, explaining that a better understanding of the complications associated with hysterectomy in obese women could facilitate patient counseling about the risks.
Dr. Matteson reported having no relevant financial disclosures.