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

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. (C) 2012 Elsevier Inc. All rights reserved.