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Locher JA, Chrysostomou M, Djokovic D, Libhaber E, van Herendael BJ, Chrysostomou A. The impact of obesity on vaginal hysterectomy and laparoscopically-assisted vaginal hysterectomy outcomes: A randomised control trial. Eur J Obstet Gynecol Reprod Biol 2023; 287:227-231. [PMID: 37390756 DOI: 10.1016/j.ejogrb.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/29/2023] [Accepted: 06/01/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVES This prospective randomised control trial aimed to compare outcome measures of vaginal hysterectomy (VH) and laparoscopically-assisted vaginal hysterectomy (LAVH) in obese vs. non-obese women undergoing hysterectomy for benign uterine conditions with a non-prolapsed uterus. The primary objective of the study was to estimate operation time, uterine weight and blood loss amongst obese and non-obese patients undergoing VH and LAVH. The secondary objective was to determine any difference in hospital stay, the need for post-operative analgesia, intra- and immediate post-operative complications, and the rate of conversion to laparotomy for obese vs. non-obese patients undergoing VH and LAVH. STUDY DESIGN A prospective randomised control study was undertaken in the Department of Obstetrics and Gynaecology of the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Women admitted between January 2017 and December 2019 for hysterectomy due to benign conditions, meeting the inclusion criteria set by the unit (vaginally accessible uterus, uterine size ≤ 12 weeks of gestation or ≤ 280gr on ultrasound examination, pathology confined to the uterus) were included in the study. The VH procedures were performed by the residents in training, under the supervision of specialists with large experience in vaginal surgery. All the LAVHs were performed by one surgeon (AC). In addition to the patient characteristics and surgical approach to hysterectomy, operative time, estimated blood loss, uterine weight, length of hospital stay, intra-operative and immediate post-operative complications were also recorded in obese and non-obese patient groups and comparatively analysed. RESULTS A total of 227 women were included in the study. 151 patients underwent VH and 76 LAVH, upon randomisation on a 2:1 basis, reflecting the habitual proportion of hysterectomy cases in the Urogynaecology and Endoscopy Unit at CMJAH. No significant differences were found in mean shift of pre-operative to post-operative serum haemoglobin, uterine weight, intra- and immediate post-operative complications, and convalescence period when comparing obese and non-obese patients in both the VH and LAVH groups. There was a statistically significant difference in operating time between the two procedures. The LAVHs took longer compared to the VHs to be performed (62.8 ± 9.3 vs. 29.9 ± 6.6 min in non-obese patients, and 62.7 ± 9.8 vs 30.0 ± 6,9 min for obese patients). All VHs and LAVHs were successfully accomplished without major complications. CONCLUSION VH and LAVH for the non-prolapsed uterus is a feasible and safe alternative for obese patients demonstrating similar perioperative outcome measures as non-obese women undergoing VH and LAVH. Where possible, VH should be preferred to LAVH as it is a safe route of hysterectomy, with operation time being significantly shorter.
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Affiliation(s)
- J A Locher
- Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg, South Africa
| | - M Chrysostomou
- Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg, South Africa.
| | - D Djokovic
- Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisbon, Portugal; Department of Obstetrics and Gynecology, NOVA Medical School - Faculdade de Ciências Médicas, NOVA University of Lisbon, Lisbon, Portugal
| | - E Libhaber
- School of Clinical Medicine and Health Sciences Research Office, University of the Witwatersrand, Johannesburg, South Africa
| | - B J van Herendael
- Department of Minimally Invasive Gynecologic Surgery, Stuivenberg General Hospital, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium; Università degli Studi dell'Insubria, Varese, Italy
| | - A Chrysostomou
- Department of Obstetrics and Gynaecology, Division Urogynaecology. University of the Witwatersrand, Johannesburg, South Africa
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Cybulsky M, Murji A, Sunderji Z, Shapiro J, Elliott C, Shirreff L. Assessing the impact of obesity on surgical quality outcomes among patients undergoing hysterectomy for benign, non-urgent indications. Eur J Obstet Gynecol Reprod Biol 2022; 274:243-250. [PMID: 35688107 DOI: 10.1016/j.ejogrb.2022.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/07/2022] [Accepted: 05/20/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the impact of body mass index (BMI) on surgical quality metrics for patients undergoing benign, non-urgent hysterectomy. STUDY DESIGN A multicentre, retrospective review at 7 hospitals in Ontario, Canada (4 academic, 3 community) was conducted. Patients undergoing hysterectomy from July 2016 to June 2019 were included. Hysterectomies for premalignant, malignant and emergency indications were excluded. The primary outcome was a composite of any complication or readmission. Secondary outcomes were grade 2 or greater complication, postoperative emergency department (ED) visit, hospital readmission, operative time (ORT) and estimated blood loss (EBL). Patient characteristics (age, ASA class, preoperative diagnoses, preoperative anemia, prior surgeries), surgical factors (endometriosis, adhesions, hysterectomy route, uterine weight, concomitant procedures, ORT, EBL) and surgeon characteristics (volume, fellowship/generalist training, academic/community hospital) were recorded along with complications, hospital readmissions and ED visits. Outcomes were evaluated using logistic regression and log-regression linear analysis grouping patients by BMI category (normal, overweight, obesity class 1, 2, and 3) and by hysterectomy route (abdominal, laparoscopic, and vaginal). RESULTS 2528 hysterectomies were performed by 67 surgeons. 828 (33%) patients had a normal BMI, 889 (35%) were overweight. 500 (20%) patients had a BMI corresponding to obesity class 1, 205 (8%) class 2 and 106 (4%) class 3. Obese patients had higher ASA class (p <.001) and more prior surgeries (p <.001) compared to patients with normal BMI. Those with class 2 and 3 obesity were younger (p <.001), had greater uterine weight (p <.001) and more intra-operative adhesions (p <.001). After controlling for covariates, there were no differences in the odds of the primary or secondary outcomes, with the exception of patients with class 2 obesity who underwent vaginal hysterectomy. They had 9.1% (11 min) significantly longer ORT (0.091, 95% CI 0.002-0.18, p <.05) and patients with an overweight BMI who underwent vaginal hysterectomy had 28 ml significantly less EBL (-0.154, 95% CI -0.26 to -0.05, p <.01) compared to patients with normal BMI. CONCLUSION BMI was not independently associated with surgical quality outcomes in patients undergoing hysterectomy for benign, non-urgent indications. Abdominal, laparoscopic, and vaginal hysterectomy can be performed safely in overweight and obese patients.
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Affiliation(s)
- Marta Cybulsky
- 123 Edward Street, Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario M5G 1E2, Canada
| | - Ally Murji
- 123 Edward Street, Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario M5G 1E2, Canada; 600 University Avenue, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario M5G 1X5, Canada
| | - Zahra Sunderji
- 600 University Avenue, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario M5G 1X5, Canada
| | - Jodi Shapiro
- 123 Edward Street, Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario M5G 1E2, Canada; 600 University Avenue, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario M5G 1X5, Canada
| | - Cara Elliott
- 1 King's College Circle, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - Lindsay Shirreff
- 123 Edward Street, Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario M5G 1E2, Canada; 600 University Avenue, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario M5G 1X5, Canada.
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Comparison of Vaginal Hysterectomy Techniques and Interventions for Benign Indications. Obstet Gynecol 2017; 129:877-886. [DOI: 10.1097/aog.0000000000001995] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ersoy E, Evliyaoğlu Ö, Erol O, Ersoy AÖ, Akgül MA, Haberal A. Effects of the morbid obesity and skin incision choices on surgical outcomes in patients undergoing total abdominal hysterectomy. Turk J Obstet Gynecol 2016; 13:189-195. [PMID: 28913120 PMCID: PMC5558291 DOI: 10.4274/tjod.67864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 11/06/2016] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the effect of obesity on surgical outcomes in patients who underwent gynecologic surgery. MATERIALS AND METHODS In total, we evaluated 132 patients who underwent total abdominal hysterectomy with or without salpingo-oophorectomy for benign gynecologic procedures at our tertiary referral gynaecology clinic. RESULTS The non-morbid obese group [body mass index (BMI) <40 kg/m2] included 94 patients, and the morbid obese group (BMI ≥40 kg/m2) included 38 patients. The perioperative outcomes of the groups were compared. The mean operative time was significantly longer for morbid obese patients than non-morbid obese patients (p<0.05). Estimated blood loss, the need for blood transfusion, postoperative hemoglobin values, and the need for an intraabdominal drain were similar between the groups. Early and late postoperative complications were significantly more frequent in the morbid obese group than the other group (p<0.05, for each). Early postoperative complications in patients who underwent vertical skin incision were significantly more frequent than in patients who underwent pfannenstiel incision (p<0.05). Late complications were comparable between the two types of skin incision. CONCLUSION Morbid obesity significantly increases the mean operative times and the postoperative complication rates of abdominal hysterectomy operations.
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Affiliation(s)
- Ebru Ersoy
- Etlik Zübeyde Hanım Women's and Children's Health Education and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Özlem Evliyaoğlu
- Etlik Zübeyde Hanım Women's and Children's Health Education and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Okyar Erol
- Etlik Zübeyde Hanım Women's and Children's Health Education and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Ali Özgür Ersoy
- Zekai Tahir Burak Women's Healthcare Training and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Mehmet Akif Akgül
- Etlik Zübeyde Hanım Women's and Children's Health Education and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
| | - Ali Haberal
- Etlik Zübeyde Hanım Women's and Children's Health Education and Research Hospital, Clinic of Obstetrics and Gynecology, Ankara, Turkey
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Abstract
Hysterectomy is the most frequently performed major surgical intervention in gynecology. Although surgically removing the uterus is invasive, it represents the most definitive treatment option for heavy menstrual bleeding. In this article, we will discuss the indications for hysterectomy as a treatment for heavy menstrual bleeding, the different approaches to perform the hysterectomy, the complications which may occur during and after this procedure and finally the outcomes in comparison with other treatment options.
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Affiliation(s)
- Eva van der Meij
- Department of Obstetrics & Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Mark Hans Emanuel
- Department of Obstetrics & Gynecology, Spaarne Gasthuis, Haarlem/Hoofddorp, The Netherlands
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Fatigue and physical function after hysterectomy measured by SF-36, ergometer, and dynamometer. Arch Gynecol Obstet 2016; 294:95-101. [DOI: 10.1007/s00404-015-3999-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/18/2015] [Indexed: 10/22/2022]
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Dhurandhar NV, Bailey D, Thomas D. Interaction of obesity and infections. Obes Rev 2015; 16:1017-29. [PMID: 26354800 DOI: 10.1111/obr.12320] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/20/2015] [Accepted: 08/03/2015] [Indexed: 12/11/2022]
Abstract
There is evidence that certain infections may induce obesity. Obese persons may also have more severe infections and have compromised response to therapies. The objective of this study is to review the available literature identifying infections that potentially contribute to greater body mass index (BMI) and differential responses of overweight and obese persons to infections. A systematic literature review of human studies examining associations between infections and weight gain, differential susceptibility, severity, and response to prevention and treatment of infection according to BMI status (January 1980-July 2014) was conducted. Three hundred and forty-three studies were eligible for inclusion. Evidence indicated that viral infection by human adenovirus Ad36 and antibiotic eradication of Helicobacter pylori were followed by weight gain. People who were overweight or obese had higher susceptibility to developing post-surgical infections, H1N1 influenza and periodontal disease. More severe infections tended to be present in people with a larger BMI. People with a higher BMI had a reduced response to vaccinations and antimicrobial drugs. Higher doses of antibiotics were more effective in obese patients. Infections may influence BMI, and BMI status may influence response to certain infections, as well as to preventive and treatment measures. These observations have potential clinical implications.
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Affiliation(s)
- N V Dhurandhar
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA
| | - D Bailey
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA
| | - D Thomas
- Center for Quantitative Obesity Research, Department of Mathematical Sciences, Montclair State University, Montclair, NJ, USA
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Bohlin KS, Ankardal M, Stjerndahl JH, Lindkvist H, Milsom I. Influence of the modifiable life-style factors body mass index and smoking on the outcome of hysterectomy. Acta Obstet Gynecol Scand 2015; 95:65-73. [PMID: 26459279 DOI: 10.1111/aogs.12794] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 09/28/2015] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The aim of this study was to study the impact of body mass index (BMI) and smoking on the outcome of hysterectomy and whether effects of these factors vary between abdominal, laparoscopic and vaginal hysterectomy. MATERIAL AND METHODS Pre-, per- and postoperative (8 weeks) data were retrieved from the Swedish National Register for Gynecological Surgery on 28 537 hysterectomies performed because of a benign indication between 2004 and 2013. Multivariable logistic regression analyses were used to identify independent factors affecting the rate of complications, presented as adjusted odds ratios (adjOR) with 95% confidence intervals (CI). RESULTS Overweight and obesity had the strongest impact on complications in the abdominal hysterectomy group. In women with a BMI ≥ 30 an increased adjOR could be seen for bleeding >1000 mL (2.90; 95% CI 2.23-3.77), peroperative complications (1.54; 95% CI 1.26-1.88), operation time >120 min (2.67; 95% CI 2.33-3.03), postoperative complications (1.21; 95% CI 1.08-1.34) and postoperative infections (1.73; 95% CI 1.50-1.99). With vaginal hysterectomy, the effect of BMI ≥ 30 could be seen in relation to excessive bleeding >500 mL (1.63; 95% CI 1.22-2.17) and operative time >120 min (2.00; 95% CI 1.60-2.50). With laparoscopic hysterectomy (LH), a BMI ≥ 30 had a higher adjOR for prolonged surgery (1.71; 95% CI 1.30-2.26). Smokers had an increased risk of postoperative infection in the abdominal hysterectomy (1.23; 95% CI 1.07-1.40) and vaginal hysterectomy groups (1.21; 95% CI 1.02-1.43) but not in the LH group. CONCLUSIONS Body mass index and smoking had a negative effect with all hysterectomy approaches but to a lesser extent in vaginal and laparoscopic hysterectomies. This should be taken into consideration in advance of surgery to improve outcome.
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Affiliation(s)
- Katja S Bohlin
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Maud Ankardal
- Department of Gynecology, Halmstad Hospital, Halmstad, Sweden
| | - Jan-Henrik Stjerndahl
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Håkan Lindkvist
- Department of Mathematics and Mathematical Statistics, Umeå University, Umeå, Sweden
| | - Ian Milsom
- Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
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Shah DK, Vitonis AF, Missmer SA. Association of body mass index and morbidity after abdominal, vaginal, and laparoscopic hysterectomy. Obstet Gynecol 2015; 125:589-598. [PMID: 25730220 DOI: 10.1097/aog.0000000000000698] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the association of body mass index (BMI) and operative time and perioperative morbidity after hysterectomy and determine whether the association varies among abdominal, laparoscopic, and vaginal approaches. METHODS Data abstracted from the American College of Surgeons National Safety and Quality Improvement Project registry included 55,409 women who underwent hysterectomy for benign conditions between January 2005 and December 2012. The relationships among BMI, operative time, and morbidity were examined, adjusting for age, race, ethnicity, year of surgery, smoking, diabetes, and American Society for Anesthesiologists physical classification. Adjusted means, incidence rate ratios, or odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using linear, Poisson, or logistic regression, respectively. RESULTS Body mass index was positively correlated with risk of wound complications and infection in women undergoing abdominal hysterectomy. Compared with those of normal BMI, women with BMIs 40 or higher had five times the odds of wound dehiscence (2.1% compared with 0.3%, crude OR 7.35, CI 3.78-14.30; adjusted OR 5.33, CI 2.63-10.8), five times the odds of wound infection (8.9% compared with 1.4%, crude OR 6.81, CI 5.00-9.27; adjusted OR 5.34, CI 3.85-7.41), and 89% higher odds of sepsis (1.3% compared with 0.6%, crude OR 2.39, CI 1.35-4.24; adjusted OR 1.89, CI 1.01-3.52). The magnitude of the association between wound infection and BMI was smaller after vaginal hysterectomy, and no increased odds of wound complications or sepsis were noted with a laparoscopic approach despite longer operative times. Operative time increased with BMI regardless of surgical approach. No associations were noted between BMI and hospital stay or thromboembolism. CONCLUSION Obesity is associated with increased wound complications and infection in women undergoing abdominal hysterectomy and with longer operative times regardless of surgical approach. Vaginal or laparoscopic hysterectomy should be performed whenever feasible. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Divya Kelath Shah
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and the Department of Obstetrics, Gynecology, and Reproductive Biology and the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, and the Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
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Nassaji M, Ghorbani R, Tamadon MR, Bitaraf M. Association between body mass index and urinary tract infection in adult patients. Nephrourol Mon 2014; 7:e22712. [PMID: 25738122 PMCID: PMC4330692 DOI: 10.5812/numonthly.22712] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 09/06/2014] [Accepted: 09/16/2014] [Indexed: 11/16/2022] Open
Abstract
Background: Overweight and obesity have become a global public health over the last decades. Obesity has been suggested to be a risk factor for some infections, but studies often showed controversial findings. Few studies examined the relationship between body mass index (BMI) and urinary tract infection (UTI), showing inconsistent results. Objectives: The purpose of this study was to determine the relationship between BMI and UTI in adult patients. Patients and Methods: Adult patients (≥ 18 years old) who were referred to clinics or admitted in hospital with diagnosis of UTI were considered for participation in the study. Control group were selected from healthy adult normal population whom underwent medical check-ups at the same hospital and without history of UTI. Data about age, gender, history of diabetes mellitus and BMI were registered for individuals who met inclusion criteria. Results: A total of 116 patients with UTI and 156 people as the control group were included in the study. Two groups were matched for age, gender and history of diabetes mellitus. Mean BMI ± SD of patients was 25.2 ± 4.0 kg/m2 and the controls was 25.1 ± 3.6 kg/m2. There was no significant correlation between BMI and UTI (P = 0.757). Mean BMI ± SD of patients with upper UTI was 25.6 ± 4.1 kg/m2 and for lower UTI was 24.9 ± 4.0 kg/m2. There was no significant difference between BMI of controls and patients with any type of UTI (P = 0.573). Conclusions: Our findings did not found an association between BMI and UTI and does not support obesity as a risk factor for UTI in adult patients.
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Affiliation(s)
- Mohammad Nassaji
- Department of Community Medicine, Research Center for Social Determinants of Health, Semnan University of Medical Sciences, Semnan, IR Iran
- Department of Internal Medicine, Kowsar Hospital, Semnan University of Medical Sciences, Semnan, IR Iran
- Corresponding author: Mohammad Nassaji, Department of Internal Medicine, Kowsar Hospital, Semnan University of Medical Sciences, Semnan, IR Iran. Tel: +98-2333437821, Fax: +98-2333437837, E-mail:
| | - Raheb Ghorbani
- Department of Community Medicine, Research Center for Social Determinants of Health, Semnan University of Medical Sciences, Semnan, IR Iran
| | - Mohammad Reza Tamadon
- Department of Internal Medicine, Kowsar Hospital, Semnan University of Medical Sciences, Semnan, IR Iran
| | - Masomeh Bitaraf
- Department of Internal Medicine, Kowsar Hospital, Semnan University of Medical Sciences, Semnan, IR Iran
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Khavanin N, Lovecchio FC, Hanwright PJ, Brill E, Milad M, Bilimoria KY, Kim JYS. The influence of BMI on perioperative morbidity following abdominal hysterectomy. Am J Obstet Gynecol 2013; 208:449.e1-6. [PMID: 23453882 DOI: 10.1016/j.ajog.2013.02.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 01/29/2013] [Accepted: 02/18/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of the study was to assess the impact of body mass index (BMI) on 30 day perioperative morbidity following abdominal hysterectomy. STUDY DESIGN The 2006-2010 National Surgical Quality Improvement Program data registry was retrospectively reviewed for patients undergoing abdominal hysterectomy. Logistic regression was used to investigate the relationship between BMI and postoperative complications. RESULTS A total of 9917 patients were captured, of which, 2219 were of an ideal BMI, 2765 were overweight, and 4933 were obese. Complications occurred in 11.3% of the procedures, with obese patients experiencing significantly higher rates of morbidity compared with overweight and nonobese patients (13.2%, 9.7%, and 9.0%, respectively; P < .001). Surgical complications were rare; however, a significant step-wise progression was observed with increasing BMI (P < .001). The rate of reoperations and overall medical complication did not differ among cohorts, although the incidence of deep vein thromboses (DVTs) was notably elevated in obese and overweight patients (P = .032). Adjusted odds ratios (ORs) found both overweight and obese patients to be at a significantly higher risk of surgical complications (OR, 1.6 and 3.0, respectively) and wound infections (OR, 1.7 and 3.0, respectively). Overweight patients were also at higher risk for DVTs (OR, 4.6) and obese patients for overall morbidity (OR, 1.4) and wound disruption (OR, 3.6). CONCLUSION Obese and overweight patients demonstrated an increased risk for periorperative morbidity following abdominal hysterectomies.
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Affiliation(s)
- Nima Khavanin
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Jo EJ, Kim TJ, Lee YY, Choi CH, Lee JW, Bae DS, Kim BG. Laparoendoscopic Single-Site Surgery With Hysterectomy in Patients With Prior Cesarean Section: Comparison of Surgical Outcomes With Bladder Dissection Techniques. J Minim Invasive Gynecol 2013; 20:160-5. [DOI: 10.1016/j.jmig.2012.09.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 09/25/2012] [Accepted: 09/27/2012] [Indexed: 11/29/2022]
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Giugale LE, Di Santo N, Smolkin ME, Havrilesky LJ, Modesitt SC. Beyond mere obesity: Effect of increasing obesity classifications on hysterectomy outcomes for uterine cancer/hyperplasia. Gynecol Oncol 2012; 127:326-31. [DOI: 10.1016/j.ygyno.2012.08.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 08/09/2012] [Accepted: 08/09/2012] [Indexed: 10/28/2022]
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Mitas L, Rogulski L, Ziebinski J. Does obesity complicate perioperative course in patients undergoing abdominal hysterectomy? Arch Gynecol Obstet 2012; 286:385-8. [PMID: 22427008 DOI: 10.1007/s00404-012-2278-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Accepted: 02/23/2012] [Indexed: 11/30/2022]
Abstract
AIM Obesity is traditionally believed to increase the incidence of perioperative complications in abdominal surgery. Recently this paradigm has been challenged mainly by observations from surgical specialties other than gynecology. Our aim was to assess the impact of obesity on perioperative course in women undergoing total abdominal hysterectomy. METHODS We analyzed medical charts of 126 patients who underwent total abdominal hysterectomy for benign gynecological conditions through a low transverse incision in the Department of Obstetrics and Gynecology of the Provincial Specialist Hospital in Czestochowa, Poland. Perioperative course was compared between obese [n = 55; body mass index (BMI) ≥ 30 kg/m(2): mean 32.6 ± 3.2 kg/m(2)] and non-obese patients (n = 71; mean BMI 24.3 ± 3 kg/m(2)). RESULTS The mean operative time in obese women was significantly prolonged (112 ± 32 vs. 100 ± 31 min, P = 0.036). However, complication rates and other perioperative outcomes were comparable between the groups. CONCLUSION In our study, mild obesity does not significantly affect the perioperative course in women undergoing total abdominal hysterectomy.
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Affiliation(s)
- Leszek Mitas
- Department of Obstetrics and Gynecology, Provincial Specialist Hospital, Polish Red Cross (PCK) Street 1, Czestochowa, Poland
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Brummer THI, Heikkinen A, Jalkanen J, Fraser J, Makinen J, Tomas E, Seppala T, Sjoberg J, Harkki P. Pharmaceutical thrombosis prophylaxis, bleeding complications and thromboembolism in a national cohort of hysterectomy for benign disease. Hum Reprod 2012; 27:1628-36. [DOI: 10.1093/humrep/des103] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Osler M, Daugbjerg S, Frederiksen BL, Ottesen B. Body mass and risk of complications after hysterectomy on benign indications. Hum Reprod 2011; 26:1512-8. [DOI: 10.1093/humrep/der060] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Harmanli O, Dandolu V, Lidicker J, Ayaz R, Panganamamula UR, Isik EF. The Effect of Obesity on Total Abdominal Hysterectomy. J Womens Health (Larchmt) 2010; 19:1915-8. [DOI: 10.1089/jwh.2010.2032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Oz Harmanli
- Department of Obstetrics and Gynecology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts
| | - Vani Dandolu
- Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Jeff Lidicker
- Temple University Center for Statistical and Information Science, Philadelphia, Pennsylvania
| | - Reyhan Ayaz
- Department of Obstetrics and Gynecology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts
| | - Uma R. Panganamamula
- Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Ebru F. Isik
- Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine, Philadelphia, Pennsylvania
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Harmanli OH, Dandolu V, Isik EF, Panganamamula UR, Lidicker J. Does obesity affect the vaginal hysterectomy outcomes? Arch Gynecol Obstet 2010; 283:795-8. [PMID: 20237934 DOI: 10.1007/s00404-010-1422-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Accepted: 03/01/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the effects of obesity on the perioperative outcomes in women who underwent vaginal hysterectomy. STUDY DESIGN In this retrospective cohort study of all women who underwent vaginal hysterectomy for benign disorders at Temple University from January 1997 to December 2002, perioperative indices were compared between 149 obese (BMI ≥ 30 kg/m(2)) and 175 non-obese women (BMI < 30 kg/m(2)). RESULTS The groups were similar with respect to age, parity, uterine weight, race, surgical indication, and previous pelvic surgery. Among medical conditions, hypertension and diabetes were significantly more common in obese women. Conversion to laparotomy occurred at similar rates in both obese (3.3%) and non-obese (5.7%) women. There was no significant difference between the groups regarding the operative time, length of hospital stay, transfusion rate, perioperative hemoglobin change, and perioperative complications (p < 0.05). CONCLUSION Obesity does not affect the perioperative outcomes and surgical complications of vaginal hysterectomy.
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Affiliation(s)
- Ozgur H Harmanli
- Department of Obstetrics and Gynecology, Baystate Medical Center, 759 Chestnut Street, Springfield, MA 01199, USA.
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Tebeu PM, Fomulu JN, Nana Njotang P, Petignat P, Tcheliebou JM, Kouam L, Doh AS. Effectiveness of vaginal hysterectomy for benign conditions in semi-urban hospital: report from Maroua-Cameroon. Trop Doct 2009; 39:200-5. [DOI: 10.1258/td.2009.080327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We assessed the effectiveness of vaginal hysterectomy for benign uterine conditions in Northern Cameroon. This is a case series study of 29 elective vaginal hysterectomies carried out between February 2005 and June 2007 in Maroua, Cameroon. Hysterocele was found as the only or associated indication in 17 (58.6%) patients, symptomatic uterine fibroids in 4 (13.8%) and other indications in 8 (27.6%) patients. The mean duration of the operation was 132 minutes and the mean blood loss at surgery was 150 ml. Twenty-five of the 28 (89.3%) women had less than seven days of hospitalisation. There was a negative correlation (r = −0.45, P = 0.015) between duration of the surgery and the order of operation. One urinary tract and one wound infection were observed. Two patients had conversion to laparotomy. This study has shown that vaginal hysterectomy is a safe and feasible method of hysterectomy in a semi-urban hospital.
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Affiliation(s)
- P M Tebeu
- Ligue d'Initiative et de Recherche Active pour la Santé et l'Education de la Femme (LIRASEF), Yaoundé
- Department of Obstetrics and Gynecology, Provincial Hospital, Maroua
| | - J N Fomulu
- Department of Obstetrics and Gynecology, University Hospitals, Yaoundé, Cameroon
| | - P Nana Njotang
- Department of Obstetrics and Gynecology, University Hospitals, Yaoundé, Cameroon
| | - P Petignat
- Department of Obstetrics and Gynecology, University Hospitals, Geneva, Switzerland
| | - J M Tcheliebou
- Department of Radiology, Provincial Hospital, Maroua, Cameroon
| | - L Kouam
- Department of Obstetrics and Gynecology, University Hospitals, Yaoundé, Cameroon
| | - A S Doh
- Department of Obstetrics and Gynecology, University Hospitals, Yaoundé, Cameroon
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Bradley CS, Kenton KS, Richter HE, Gao X, Zyczynski HM, Weber AM, Nygaard IE. Obesity and outcomes after sacrocolpopexy. Am J Obstet Gynecol 2008; 199:690.e1-8. [PMID: 18845288 DOI: 10.1016/j.ajog.2008.07.030] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 05/17/2008] [Accepted: 07/11/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to compare outcomes after sacrocolpopexy (SC) between obese and healthy-weight women. STUDY DESIGN Baseline and postoperative data were analyzed from the Colpopexy And Urinary Reduction Efforts (CARE) randomized trial of SC with or without Burch colposuspension in stress continent women with stages II-IV prolapse. Outcomes and complications were compared between obese and healthy-weight women. RESULTS CARE participants included 74 obese (body mass index >/=30 kg/m(2)), 122 overweight (25-29.9 kg/m(2)), and 125 healthy-weight (18.5-24.9 kg/m(2)) women, and 1 underweight (< 18.5 kg/m(2)) woman. Compared to healthy-weight women, obese women were younger (59.0 +/- 9.9 vs 62.1 +/- 10.3 yrs; P = .04), more likely to have stage II prolapse (25.7% vs 11.2%; P = .01), and had longer operative times (189 +/- 52 vs 169 +/- 58 min; P = .02). Two years after surgery, stress incontinence, prolapse, symptom resolution, and satisfaction did not differ between the obese and healthy-weight groups. CONCLUSION Most outcomes and complication rates after SC are similar in obese and healthy-weight women.
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Penketh R, Griffiths A, Chawathe S. A prospective observational study of the safety and acceptability of vaginal hysterectomy performed in a 24-hour day case surgery setting. BJOG 2007; 114:430-6. [PMID: 17378817 DOI: 10.1111/j.1471-0528.2007.01269.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the safety and acceptability of vaginal hysterectomy with and without simultaneous oophorectomy in a 24-hour day case surgery setting for women with nonprolapse indications for surgery. DESIGN Prospective observational study. SETTING A busy teaching hospital and tertiary referral centre for Obstetrics and Gynaecology. POPULATION Seventy-one women from one consultant's practice underwent a vaginal hysterectomy with a planned discharge within 24 hours after the procedure. All women had a body mass index less than 40 and a suitable home environment for routine day case surgery, other than that the women were from an unselected population. METHOD Prospective observational study. MAIN OUTCOME MEASURES The duration of the operation and mean blood loss were recorded. Any intraoperative complications were noted. In addition, the proportion of women discharged home within 24 hours of the operation was recorded together with any readmissions to hospital. Returns to theatres and any postoperative complications were also recorded. Postoperative pain scores were assessed 6 and 24 hours after procedure in selected women. RESULTS Seventy-one vaginal hysterectomies were performed as 24-hour day case procedures. The intraoperative complication rate was 1.4%. Sixty-five women were discharged home within 24 hours (91.5%). The readmission rate within this group was 6.2%. The duration of the procedure, mean blood loss, return to theatre rate and incidence of febrile illness were comparable with rates recorded in inpatient studies. CONCLUSIONS Vaginal hysterectomy performed as a 24-hour day case procedure appears to be as safe as traditional inpatient management, with a high rate of early discharge and a low rate of readmission. This may have additional advantages for the woman and healthcare provider alike.
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Affiliation(s)
- R Penketh
- Department of Obstetrics and Gynaecology, University Hospital of Wales, Heath Park, Cardiff, UK
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Patel N, Bagan B, Vadera S, Maltenfort MG, Deutsch H, Vaccaro AR, Harrop J, Sharan A, Ratliff JK. Obesity and spine surgery: relation to perioperative complications. J Neurosurg Spine 2007; 6:291-7. [PMID: 17436915 DOI: 10.3171/spi.2007.6.4.1] [Citation(s) in RCA: 323] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Object
Many patients undergoing elective thoracic or lumbar fusion procedures are obese, but the contribution of obesity to complications in spine surgery has not been defined. The authors retrospectively assessed the prevalence of obesity in a cohort of patients undergoing thoracic and lumbar fusion and correlate the presence of obesity with the incidence of operative complications.
Methods
A retrospective review of consecutive patients treated by a single surgeon (J.K.R.) over a 36-month period at either Rush University Medical Center or the Neurological and Orthopedic Institute of Chicago was performed. The authors identified 332 elective thoracic and lumbar spine surgery cases; the cohort was restricted to include only patients with symptomatic degenerative conditions in need of an anterior, posterior, or combined anterior–posterior fusion. Cases of trauma, tumor, and infection and any case in which the procedure was performed for emergency indications were excluded. A total of 97 cases were identified; of these 86 procedures performed in 84 patients had adequate follow-up material for inclusion in the present study. A broad definition of complications was used. Complications were divided into adverse events (minor) and significant complications (major) based on their impact on patient outcome. Stepwise multivariate logistic regression was used to identify which variables had a significant effect on the risk of complications. Variables considered were body mass index (BMI), height, weight, age, sex, presence or absence of diabetes mellitus (DM) and/or hypertension, number of levels fused (single compared with multiple), and type of surgery performed.
The mean BMI for the cohort was 28.8 (95% confidence interval 24.4–30.3); 60 patients (71.4%) were considered overweight or obese (BMI ≥ 25). There were 42 complications in 31 patients (36.9%); this included 19 significant complications in 17 patients (20.2%). Logistic regression revealed that the probability of a significant complication was related to BMI (p < 0.04); the chance of a significant complication was 14% with a BMI of 25, 20% with a BMI of 30, and 36% with a BMI of 40. Positioning-related palsies were only found in extremely obese patients (BMI ≥ 40). The probability of minor complication occurrence increased with age (p < 0.02), not BMI. The rate of complications was independent of sex as well as the presence of DM or hypertension. A standard collection of complications occurred, including wound infection (three cases), cerebrospinal fluid leakage (eight cases, one requiring reoperation), deep vein thrombosis (two cases), cardiac events (four cases), symptomatic pseudarthrosis (one case), pneumonia (three cases), prolonged intubation (two cases), urological issues (eight cases), positioning-related palsy (two cases), and neuropathic pain (two cases).
Conclusions
Obesity is a prevalent condition in patients undergoing elective fusion for degenerative spinal conditions and may increase the prevalence and incidence of perioperative complications. In their analysis, the authors correlated increasing BMI and increased risk of significant postoperative complications. The correlation of obesity and perioperative complications may assist in the preoperative evaluation and selection of patients for surgery.
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Affiliation(s)
- Nimesh Patel
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
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Rogers RG, Lebküchner U, Kammerer-Doak DN, Thompson PK, Walters MD, Nygaard IE. Obesity and retropubic surgery for stress incontinence: is there really an increased risk of intraoperative complications? Am J Obstet Gynecol 2006; 195:1794-8. [PMID: 17014816 DOI: 10.1016/j.ajog.2006.07.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Revised: 06/01/2006] [Accepted: 07/05/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate the impact of obesity on length of surgery, blood loss, and intra- and postoperative complications in women who underwent retropubic surgery for stress urinary incontinence. STUDY DESIGN Of 449 women participating in a multicenter, randomized trial evaluating antibiotic prophylaxis in women with suprapubic catheters, 250 women underwent retropubic anti-incontinence procedures. This is a prospective nested cohort study of these women, 79 (32%) of whom were obese (body mass index 30 or greater) and 171 (68%) overweight or normal weight (body mass index less than 30). Data collected included demographic variables, past medical history, physical examination, and intraoperative and postoperative complications. Data were analyzed with Fisher's exact for dichotomous variables, Student t tests for continuous variables, and analysis of variance for multivariate analysis. Significance was set at P < .05. RESULTS Obese women undergoing stress urinary incontinence surgery were younger than nonobese women (48.7 versus 51.9 years, respectively, P < .019). The number and type of additional surgeries performed were similar between groups with the exception that obese women were less likely to undergo abdominal apical suspensions (P = .006) or abdominal paravaginal repairs (P = .001); therefore, estimated blood loss, change in hematocrit, length of stay, surgery, and suprapubic catheterization comparisons are adjusted for the performance of these procedures. Estimated surgical blood loss was greater for obese women (344 versus 284 P = .03); however, change in hematocrit was lower for obese than nonobese women (6.6 versus 7.3, P = .048). Mean length of surgery was 15 minutes longer in obese women (P = .02). Length of hospital stay did not vary between groups (P = NS). Major intraoperative complications were uncommon (14 [5.6%]), with no difference between weight groups. Incidence of postoperative urinary tract infection, wound infections, or postoperative major complications were likewise similar between groups (all P > .05). CONCLUSION Surgery takes longer for obese patients, but blood loss as recorded by change in hematocrit is lower. Major complications were rare and similar between weight groups, as were infectious complications.
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Affiliation(s)
- R G Rogers
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA
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von Gruenigen VE, Gil KM, Frasure HE, Jenison EL, Hopkins MP. The impact of obesity and age on quality of life in gynecologic surgery. Am J Obstet Gynecol 2005; 193:1369-75. [PMID: 16202728 DOI: 10.1016/j.ajog.2005.03.038] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Revised: 03/07/2005] [Accepted: 03/07/2005] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study was undertaken to prospectively evaluate the effect of early stage endometrial cancer, age, and obesity on quality of life (QOL). STUDY DESIGN Women undergoing surgery for endometrial cancer or an adnexal mass determined at surgery to be benign (controls) were enrolled preoperatively and followed for 6 months. RESULTS Seventy-nine women completed the study. Functional Assessment of Cancer Therapy (FACT-G) scores increased significantly in all women; however, significant differences by patient weight and age were obtained. Obesity was associated with decreased physical FACT-G and SF-36 scores. Older women had lower SF-36 physical scores, higher emotional scores, and less change over time. CONCLUSION Women with early endometrial cancer had similar changes in QOL as those who received surgery for benign disease. Obese and elderly women had domain alterations. Given the aging population and rising incidence of obesity, these results emphasize the need for QOL interventions in postoperative gynecologic care of these patients.
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Affiliation(s)
- Vivian E von Gruenigen
- University Hospitals of Cleveland, MacDonald Womens Hospital, The Ireland Cancer Center, Cleveland, OH, USA.
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