Obesity appeared to have a negative impact on clinical and financial outcomes for patients undergoing minimally invasive hysterectomies, according to a retrospective cohort study.
Patients with obesity who underwent this surgery for benign indications had a longer operating room (OR) time compared with patients who were not obese (204 vs 181 minutes), as well as a higher estimated blood loss (375 mL vs 302 mL), reported Margot Le Neveu, MD, of Johns Hopkins Medicine in Baltimore.
Class III obesity (defined as a body mass index [BMI] over 40) accentuated these outcomes, with these patients experiencing the longest OR times (220 minutes) and greatest amount of blood loss (475 mL), Le Neveu said during her virtual presentation at the American Association of Gynecologic Laparoscopists annual meeting.
In addition, class III obesity was a significant predictor of hysterectomy cost (P=0.37) However, obesity was not significantly associated with costs, she noted.
"Our results demonstrate that obesity appears to have a significant impact on clinical and financial outcomes of benign hysterectomy that is approach-dependent, and most notable among patients with class III obesity," Le Neveu said.
These findings underscore the importance of weight management counseling for patients prior to operations, she added.
Le Neveu and colleagues analyzed all adult patients who underwent a minimally invasive hysterectomy from 2013 to 2019 at five hospitals affiliated with the Johns Hopkins system. They categorized hysterectomy by surgical approach, and grouped patients by their BMI. Patients were defined as non-obese (BMI under 30), obese (BMI 30 to 39), and class III obese (BMI over 40).
The researchers measured OR time, estimated blood loss, length of hospital stay, and hospital charges. They also evaluated adverse perioperative outcomes, including blood transfusions, organ injury, conversion to laparotomy, readmission within 30 days, emergency department visit, or OR takeback.
Overall, 2,494 patients underwent a minimally invasive hysterectomy during the study period. The most common surgical approach was laparoscopic surgery (78.5% of patients). About 14% of patients underwent a robotic approach, and 8% underwent vaginal surgery. Mean age of patients was 48, and mean BMI was 30. Mean total cost for a hysterectomy was $13,928.
Obesity did not appear to have an impact on length of hospital stay or risk of adverse perioperative events, Le Neveu noted.
When stratified by surgical approach, obesity was not a significant predictor of cost for robotic or vaginal hysterectomies. However, in the laparoscopic group, class III obesity was associated with increased costs by nearly $900, though obesity was associated with a decreased cost by around $700 compared with patients who were not obese.
Le Neveu recognized that this study was subject to selection bias, since it was retrospective and patients could not be randomized to a surgical approach. Additionally, factors such as concomitant procedures that were not identified in the dataset may have confounded these results. This study may also be limited by the variability in procedure costs.
Disclosures
This study was supported in part by a grant from the NIH.
Le Neveu and co-authors did not disclose any potential conflicts of interest.
Primary Source
American Association of Gynecologic Laparoscopists
Le Neveu M, et al "Impact of body mass index on clinical and financial outcomes of benign minimally invasive hysterectomy" AAGL 2021; Virtual Poster 5616.