Impact of obesity on perioperative complication for pelvic organ prolapse surgery

Objectives:
To analyze the association of obesity on 30-day postoperative complications following surgery for pelvic organ prolapse (POP).





Methods:
This was a database study comparing postoperative complications following POP surgery of obese versus non-obese patients utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). The ACS-NSQIP collects perioperative risk factors, intraoperative variables, and 30-day postoperative mortality and morbidity outcomes on patients undergoing surgery. Utilizing the 2015 to 2019 ACS-NSQIP Gynecology Participant Use Data File (PUF), patients who underwent surgery for uterovaginal or vaginal vault prolapse were selected. Perioperative outcomes were compared between obese and nonobese patients. Obesity was defined as a body mass index (BMI) greater than or equal to 30 kg/m2. Group comparisons with student’s t-test and chi square Fisher’s exact test were used as appropriate. A multivariable logistic regression was performed to determine if obesity was associated with any 30-day complication after controlling for confounders.





Results:
13,302 patients met inclusion criteria and were included in this study. 4815 patients were obese (36.2%) with a mean BMI of 34.7 (±4.4), while 8487 (63.8%) were nonobese with a mean BMI of 25.7 (±2.7). Patients in the obese cohort were more likely to be younger (59.6
± 12.0 years vs 62.17 ± 12.3, p< 0.001). Hypertension, longer operative time, and concomitant incontinence sling were more common in the obese cohort (Table 1). The overall rate of any 30- day postoperative complication was 6.8%, and the rate of complications did not differ between obese and nonobese patients (7.3% vs 6.5%, p=0.11). The most common complication was urinary tract infection (4.3%), and this did not differ between the two cohorts. Superficial (0.5% vs 0.9%, p=0.013) and organ space surgical site infection (0.8% vs 0.4%, p=0.007) were significantly higher in the obese cohort, while nonobese patients were more likely to receive a blood transfusion (0.6% vs 1.1%, p=0.005). Other wound, respiratory, renal, cardiovascular, and infectious complications were similar between the two groups (Table 1). Factors that differed significantly between obese and non-obese patients on bivariate analyses were included in the multivariable logistic regression model. After controlling for potential confounding factors, obesity was not associated with any 30-day postoperative compilations following POP surgery (Table 2).





Conclusions:
Obesity was not associated with 30-day postoperative complications following surgery for POP after controlling for possible confounding variables. This is one of the first studies to analyze the association of obesity and postoperative complications following POP surgery using a national surgical quality database.