Abstract and Introduction
Abstract
Background: This study examines BMI in relation to risk of complications after hysterectomy on benign indications, and explores whether any associations vary by route of surgery.
Methods: In this cohort study, we included data on health and lifestyle collected prospectively for all hysterectomy referrals for benign indications in Denmark from 2004 to 2009. Logistic regression was used to investigate relationship between BMI and complications reported at surgery or during the first 30 days after surgery.
Results: Of the 20 353 women with complete data, 6.0% had a BMI < 20 kg/m, 31.9% with BMI between 25 and 30 kg/m (classified as overweight) and 17.5% with a BMI ≥ 30 kg/m (categorized as obese). The overall rate of complications was 17.6%, with bleeding being the most common specific complication (6.8%). After adjustment for age, ethnicity, education, indication for surgery, uterus weight, use of prophylaxis, American Society of Anaesthesiologists classification, co-morbidity status and route of hysterectomy, obesity was associated with an increased risk of heavy bleeding during surgery [odds ratio (OR) = 3.64 (2.90–4.56)], all bleeding complications [OR = 1.27 (1.08–1.48)] and infection [OR = 1.47 (1.23–1.77)]. The risk of all bleeding complications [OR = 1.48 (1.28–1.82)] and re-operation [OR = 1.66 (1.26–2.17)] were also increased among women with a BMI < 20. This U-shaped relation between BMI and bleeding, and the association between high BMI and infections were only seen for the abdominal route [abdominal hysterectomy (AH)]. The risk of infections was elevated among women with BMI<20 who underwent laparoscopic surgery [laparoscopic hysterectomy (LH)].
Conclusions: Obesity increases the risks of bleeding and infections after AH. A BMI below 20 seems to increase the risks of bleeding and infection after AH and LH, respectively.
Introduction
Hysterectomy is the most common major gynaecological operation in the world. A high BMI is a risk factor for a number of diseases leading to hysterectomy such as fibroids and abnormal uterine bleeding (Laughlin et al., 2010). BMI also seems to be associated with the risk of complications after most elective surgical procedures (Choban and Flancbaum, 1997); however, the studies that have examined whether BMI is associated with risk of complications after hysterectomy have been inconsistent (Holub et al., 2001; Löfgren et al., 2004; Rasmussen et al., 2004; Chopin et al., 2009). In addition, many focused on one specific route of surgery, and included only small and selected groups of patients. One of the largest, recent studies included 1460 patients who underwent laparoscopic hysterectomy (LH) for benign conditions, and showed that a BMI > 30 kg/m was not associated with an increased risk of peri- or post-operative complications, but a longer operating time was found for the obese women (Chopin et al., 2009). In a larger, nationwide Swedish study, with focus on post-operative infections, Löfgren et al. (2004) found that high BMI was a risk factor in 3297 women undergoing elective abdominal hysterectomy (AH) or vaginal hysterectomy (VH).
In the present study, we use prospectively collected data from a large national database to analyse whether BMI is associated with an increased risk of complications within 30 days after hysterectomy for benign indications. We also explore whether any risks associated with BMI differed in relation to whether the route of surgery was abdominal, vaginal or laparoscopic.