CHICAGO – The rate of total abdominal hysterectomy increased, and the rates of total vaginal hysterectomy and laparoscopic-assisted vaginal hysterectomy decreased in tandem with increasing body mass index among women included in the American College of Surgeons–National Surgical Quality Improvement Program database.
Of 18,810 women included in the database, 9,852 (52.38%) had total abdominal hysterectomy (TAH), 5,146 (27.36%) underwent total vaginal hysterectomy (TVH), 2,296 (12.21%) underwent laparoscopic-assisted vaginal hysterectomy (LAVH), and 1,516 (8.06%) had total laparoscopic hysterectomy (TLH).
The increases in TAH, and the decreases in TVH and LAVH, were statistically significant across four BMI categories (less than 25 kg/m2, 24 to less than 30, 30 to less than 40, and 40 or greater); TLH rates did not change significantly based on BMI, Dr. Emad Mikhail of the University of South Florida, Tampa, reported in a poster at the annual meeting of the American Congress of Obstetricians and Gynecologists
Operative time also increased in tandem with BMI. For example, operative times in the four BMI groups, respectively, were 90, 96, 106, and 125 minutes for TAH; 78, 87, 87, and 88.5 minutes for TVH; 103, 109, 117, and 136 minutes for LAVH; and 122, 135, 130, and 153 minutes for TLH.
Wound infection rates in the TAH group, but not in the other groups, also increased with increasing BMI, with 4, 6, 26, and 35 infections occurring in the groups, respectively, Dr. Mikhail noted.
Patients included in the database were women who underwent hysterectomy for benign indications between 2005 and 2011. The study was undertaken to determine whether obesity has any association with the recent trends with respect to routes chosen for hysterectomy for benign indications.
Obese patients are expected to benefit from minimally invasive procedures, including vaginal and laparoscopic hysterectomy, but these results suggest that obesity increases the likelihood of TAH, which increases morbidity, Dr. Mikhail concluded. Future studies should evaluate the effects of implementation of robotic-assisted TLH on these trends, especially for morbidly obese women, he added.
Dr. Mikhail reported having no relevant financial disclosures.