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Obesity and Reconstructive Pelvic Surgery: An ACS NSQIP Study
Sarah Ashmore1, Kimberly Kenton1, Deepanjana Das2
1From the Section of Urogynecology and Reconstructive Pelvic Surgery, University of Chicago.
Insights
Obesity did not increase 30-day complications after reconstructive pelvic surgery (RPS). This study found no significant difference in overall complications between obese and nonobese patients undergoing RPS.
Area of Science:
- Urology
- Gynecology
- Surgical Outcomes
Background:
- Obesity is a growing concern in the US, linked to various medical and surgical risks.
- Limited data exists on obesity as an independent factor for complications following reconstructive pelvic surgery (RPS).
Purpose of the Study:
- To investigate the association between obesity and 30-day perioperative complications after RPS.
- To compare outcomes in obese versus nonobese patients undergoing RPS.
Main Methods:
- A retrospective database study using the American College of Surgeons National Surgical Quality Improvement Program.
- Compared outcomes for 13,302 patients (4,815 obese, 8,487 nonobese) undergoing RPS for pelvic organ prolapse.
- Obesity defined as body mass index ≥30 kg/m².
Main Results:
- Overall 30-day complication rate was 6.8% with no significant difference between obese and nonobese groups.
- Obese patients had higher rates of superficial and organ space surgical site infections.
- Nonobese patients were more likely to require blood transfusions.
- Multivariable analysis, controlling for confounders, found obesity not associated with any 30-day postoperative complications.
Conclusions:
- After adjusting for confounding factors, obesity is not linked to 30-day postoperative complications following reconstructive pelvic surgery.
- Findings suggest obesity may not be an independent risk factor for overall perioperative complications in RPS.
Importance:
Obesity is steadily increasing in the United States and is a risk factor for many medical and surgical complications. Literature is limited regarding obesity as an independent risk factor for perioperative complications after reconstructive pelvic surgery (RPS).
Objective:
This study aimed to analyze the association of obesity on 30-day perioperative complications after RPS.
Study Design:
This was a database study comparing perioperative complications after RPS of obese versus nonobese patients using the American College of Surgeons National Surgical Quality Improvement Program. Patients who underwent surgery for uterovaginal or vaginal vault prolapse were selected, and perioperative outcomes were compared between obese and nonobese patients. Obesity was defined as a body mass index ≥30 (calculated as weight in kilograms divided by height in meters squared).
Results:
A total of 13,302 patients met the inclusion criteria and were included in this study; 4,815 patients were obese, whereas 8,487 were nonobese. The overall rate of any 30-day postoperative complication was 6.8%, and the rate of complications did not differ between groups. Superficial and organ space surgical site infections were significantly higher in the obese cohort, whereas nonobese patients were more likely to receive a blood transfusion. A multivariable logistic regression model was performed with variables that were statistically significant on bivariate analysis and deemed clinically significant. Variables included obesity, age, American Society of Anesthesiologists class, current smoker, diabetes, hypertension, operative time, colpopexy, and obliterative procedure. After controlling for potential confounding factors, obesity was not associated with any 30-day postoperative complications after pelvic organ prolapse surgery.
Conclusion:
Obesity was not associated with 30-day postoperative complications after RPS after controlling for possible confounding variables.
