The impact of body mass index on surgical complications in minimally invasive hysterectomy for uterine fibroids

Research question: We aimed to assess the impact of Body Mass Index (BMI) on 30-day postoperative complications in patients undergoing minimally invasive hysterectomy (MIH) for fibroids.

Design: Using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2012-2020), we analyzed major and minor 30-day postoperative complications, stratified by BMI, in patients with uterine fibroids who underwent MIH. Complications were stratified according to the Clavien-Dindo classification.

Results: Among 61,192 patients, overall complication rates ranged from 6.3 % to 8.1 %, with the highest rates in obesity class 3. Significant differences were observed in minor complication rates across BMI groups, though major complication rates did not significantly vary. Higher BMI classes correlated with longer operative times, with mean durations ranging from 127.1 min in the lowest BMI group to 158.1 min in the highest BMI group (p < 0.001). In multivariable regression, higher BMI was associated with increased odds of minor complications [</≥34.5 kg/m², aOR 95 % CI = 1.10 (1.01-1.21)]. There was no significant association between lower and higher BMI (</≥32.8 kg/m²) and major complications. Additionally, overweight, obesity class 2 and 3 were independently associated with lower odds of major complications [aOR 95 % CI 0.82 (0.71-0.94), 0.77 (0.64-0.92) and 0.82 (0.67-1.00), respectively], compared to the normal BMI group. BMI categories were not independently associated with any or minor complications compared to normal the normal BMI category.

Conclusion: After adjusting for confounding factors, overweight, obesity class 2 and 3 are associated with a decreased risk of major complications compared to normal BMI. In contrast, BMI categories were not associated with any- or minor complications. Higher BMI classes were associated with longer operative times.