The Impact of Obesity on Perioperative Complications in Prolapse Patients ≥ 70 Years Old

Obesity is a recognized risk factor for developing pelvic organ prolapse and for perioperative complications. As the population ages, an increasing number of older, obese individuals with prolapse may opt for surgical repair. This study assesses the association between obesity and short-term perioperative adverse events (AEs) in women ≥ 70 years undergoing vaginal and laparoscopic prolapse surgery.

This is a secondary analysis of a retrospective cohort study of older women undergoing vaginal and laparoscopic prolapse surgery at two medical centers from 2016 to 2023. Patients were classified as nonobese (< 30 kg/m²), class 1 obese (30-34.9 kg/m²), or class 2+ obese (≥ 35 kg/m²). The primary outcome was composite AEs within 8 weeks after surgery, and secondary outcomes included major AEs and individual AEs.

Of 1507 older women, 20.8% (n = 314) were class 1 obese and 6.0% (n = 90) were class 2+ obese. Obese patients were younger and more likely to be frail, hypertensive, and diabetic (p < 0.05). Obese patients experienced greater estimated intraoperative blood loss (p < 0.05). Obesity was not associated with composite AEs or major AEs on multivariable analysis, but was found to be predictive of postoperative hematoma. Class 1 obese women had a 2.7-times greater odds (95% CI 1.17-6.22) and class 2+ obese women had a 4.7-times greater odds (95% CI 1.61-13.43) of hematoma compared to nonobese women. Obesity was not associated with major hematoma, defined as ≥5 cm or requiring medical or surgical intervention.

Obesity in older surgical patients is not associated with a greater incidence of composite AEs, but may be associated with postoperative hematomas.