Outcome of different routes of hysterectomy by uterine weight in overweight and obese patients
Salvo N, Siddiqui D, Bernhard K, Chauhan SP, Chen H-Y. Outcome of different routes of hysterectomy by uterine weight in overweight and obese patients. J Patient-Centered Res Rev. 2014;1:54.
Presented at 2013 Aurora Scientific Day, Milwaukee, WI
Background/significance: Hysterectomy is the second most common surgical procedure done in the United States. Obesity and uterine weight contribute to length and difficulty of surgery. There is a paucity of reports on post-operative morbidity among overweight/obese women with large uteri.
Purpose: Compare perioperative outcomes among overweight (≥25 kg/m2) and obese (≥30 kg/m2) women with uterine weight (<250 vs. ≥250g) undergoing different routes of hysterectomy for 12/2011) was conducted. Inclusion criteria were BMI≥25 and known uterine weight. Exclusion criteria were hysterectomies for malignant or obstetrical indications. Variables included demographics, indications, pathology, route, operative times, co-morbidities, length of stay, primary surgeon years of practice, reoperation, follow-up, and surgical cost. Outcomes included surgical complications (urinary tract, bowel, vascular, and nerve injuries, ileus, postoperative hemorrhage), wound complications (surgical site infection, seroma, hematoma), cuff complications (dehiscence, cellulitis, pelvic abscess), and medical complications (febrile, urinary, VTE, respiratory).
Results: 1,079 hysterectomies were performed and 78% (828) met the inclusion criteria. 29% (245) were overweight and 71% (585) obese. Majority were African-American (77.4%). 52% (427) underwent abdominal hysterectomy (AH), 27% (221) underwent laparoscopic hysterectomy (LH), and 22% (180) underwent vaginal hysterectomy (VH). Indications for hysterectomy included uterine fibroids (80.6%) and menorrhagia (87.1%). Hypertension was found in 40.2% of the patients while 21.9% were anemic prior to surgery. 25% of patients had a prior cesarean section (23.9%) or laparotomy (24.5%). Comparing <250g and >250g uteri, differences in wound (p=0.047) and cuff (p=0.027) complications for VH and for AH (p=0.017) were statistically significant. Taking uterine weight into consideration, operating time (p<0.001) for both AH and LH, surgical cost (p<0.001) for LH, and readmission rate for VH (p=0.014) were statistically significant.
Conclusion: Among overweight and obese women, regardless of uterine weight, there was no difference among the three routes of hysterectomies for overall complications. Regardless of uterine weight, cuff complications (p=0.002) was highest in VH (14%). In ≥250g, cuff complications were significantly higher in VH (27%).