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Association Between Obesity and Surgical Outcomes in patients undergoing minimally invasive Hysterectomy
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  • Randa Jalloul ,
  • Olivia Dziadek,
  • Clara Ward,
  • Michal Bartal
Randa Jalloul
UTHealth

Corresponding Author:[email protected]

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Olivia Dziadek
UTHealth
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Clara Ward
UTHealth
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Michal Bartal
UTHealth
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Abstract

Objective: To investigate morbidity associated with minimal invasive hysterectomy in obese women. Design: This is a retrospective cohort study using the National Surgical Quality Improvement Project database from 2014 to 2017. Individuals that underwent a laparoscopic, robotic or vaginal hysterectomy were included in the study. Our primary outcome was the composite morbidity (including surgical site infection, sepsis, pulmonary, thromboembolic, cardiac and renal complications, and death). Our secondary outcomes included length of hospital stay, readmission, reoperation, and other surgical complications. A multivariable logistic regression was performed adjusting for age, race, American society of anesthesiology classification (ASA), smoking, surgical approach and operation time. Setting: Hospitals participating in the National Surgical Quality Improvement Project database. Patients or Participants:  Patients undergoing minimally invasive hysterectomy for benign disease. Measurements and Main Results:  39,368 individuals underwent hysterectomies; 18,767 (47.8%) were obese. Class II obesity or more was associated with increased risk for the primary outcome compared to nonobese women. The difference in the primary outcome primarily was driven by an increased risk of superficial site infection. Class III obesity was associated with increased risk for length of stay. There was no difference in the rate of ureteral/bladder/bowel injury, urinary tract infection, blood transfusion, readmission, surgical site closure or reoperation between obese and nonobese women. Conclusion: The rate of surgical morbidity in obese women undergoing minimally invasive hysterectomy remains higher. It is driven by surgical site infection. Future interventions such as preoperative optimization as well as specific wound care interventions in obese patients should be emphasized