For a study, researchers sought to evaluate 30-day hysterectomy results by body mass index (BMI) categorization and to estimate changes in 30-day outcomes by BMI over time. It was a retrospective cohort analysis of individuals over the age of 18 who had hysterectomy between 2005 and 2018, using data from the National Surgical Quality Improvement Program database. Exclusions were done for uncertain indications or surgical routes, as well as missing values in covariates or outcome variables of relevance. The characteristics and outcomes of patients were examined across BMI categories. The outcomes included the duration of stay, surgical time, and major and minor problems. For continuous outcomes, multivariable linear regression models were utilized, while for binary outcomes, modified Poisson regression models were used. Patients with benign and malignant hysterectomy indications were studied independently. Age, race, hysterectomy route, hypertension, diabetes, smoking, chosen preoperative laboratory results, and cancer kind, if appropriate, were all factored into the models.

Obesity rose from 41.2% in 2005–2007 to 51.8% in 2018. Minimally invasive surgery was the most commonly used method among 319,462 patients (58.8% vs 24.5% laparotomy vs 16.7% vaginal). Higher BMI classifications were associated with longer operative times (benign indication: 25.0 minutes longer, 95% CI 22.1–27.9; malignant indication: 25.1 minutes longer, 95% CI 20.8–29.4) and a higher risk of complications compared to normal-weight BMIs, though operative time decreased over time for patients with malignant surgical indications. Major problems did not rise in comparison to normal-weight individuals until a BMI of 40 for benign hysterectomy and 50 for malignant hysterectomy. 

Complications and operating times when undergoing a hysterectomy, both increase with weight. Knowledge of evolving risk levels at various weight subclassifications might enhance preoperative shared decision making.

Reference:journals.lww.com/greenjournal/Fulltext/2022/04000/Evaluation_of_Surgical_Morbidity_After.15.aspx