Perioperative Outcomes of Major Laparoscopic Surgery for Benign Gynecologic Conditions and the Role of Body Mass...

Analyze the association of Body Mass Index (BMI) and perioperative outcomes following major laparoscopic surgery for benign gynecologic conditions.

Retrospective exploratory Institutional Review Board exempt study.

Single-site academic institution.

Patients ≥18 years old who underwent major laparoscopic surgery from January 2018 to December 2023 by minimally invasive gynecologic surgeons.

Surgery type and perioperative outcomes by obesity class (not overweight, overweight, Class I, Class II, Class III, Class IV, and V) were compared. Manual chart review was conducted using REDCap software. Trend tests compared variables across BMI categories using a p-value of .05 as the significance level. Complications were categorized by CLASSIC and Clavien-Dindo classifications. An adjusted regression analysis assessed the impact of BMI on complications and procedure times.

Of the 883 patients, 489 (55%) were classified as obese, with 126 (14%) patients meeting criteria for Class III obesity and 31 (4%) with a BMI ≥ 50 kg/m² (Class IV and V). Patients with higher BMI categories were more likely to identify as a non-white race, have comorbidities, and have Medicaid insurance. Patients with higher BMI categories had a higher likelihood of comorbidities (p <.001). Increasing BMI was also associated with higher estimated blood loss, blood transfusion, longer procedure times, and longer length of stay (p <.001). Complications were increased with higher BMI on univariate, but not multivariate, analysis. There were no significant differences in postoperative complications categorized by Clavien-Dindo Classification, readmission rates, or conversion to laparotomy among BMI categories.

Higher BMI groups had an overall increased risk of complications compared to non-obese individuals, a difference that was not present after adjustment for confounding factors. In addition, postoperative complication rates were not different following major laparoscopic surgery for benign gynecologic conditions.