The Relationship Between Obesity and Trends of the Routes of Hysterectomy for Benign Indications

INTRODUCTION: The objective of this study was to determine if obesity has an effect on the recent trends of routes chosen for hysterectomy for benign indications. Patients with elevated body mass index (BMI) experience a higher risk for perioperative morbidity and are expected to benefit from minimally invasive surgical approaches. METHODS: Using the American College of Surgeons National Surgical Quality Improvement Program database, patients who underwent hysterectomy for benign indications from 2005 to 2011 were identified by International Classification of Diseases, 9th Revision codes and were categorized into total abdominal hysterectomy (TAH), total vaginal hysterectomy (TVH), laparoscopically assisted vaginal hysterectomy (LAVH), and total laparoscopic hysterectomy (TLH) using Current Procedural Terminology codes. Patients were divided into four groups according to BMI (BMI less than 25 kg/m2, BMI 25–29.9 kg/m2, BMI 30–39.9 kg/m2, and BMI 40 kg/m2 or greater). The data were analyzed using tests for trend, Wilcoxon rank, and Fisher's exact tests. RESULTS: A total of 18,810 patients underwent hysterectomy for benign indications: 9,852 (52.38%) TAH, 5,146 (27.36%) TVH, 2,296 (12.21%) LAVH, and 1,516 (8.06%) TLH. The TAH rates increase as BMI increases (P<.001). The TVH rates decreases as BMI increases (P<.001). The LAVH rates decrease as well as BMI increases (P=.04). There was no significant difference in TLH rates (P=.61). The BMI increase was associated with an in increase in operative time (P<.001) in all groups. Wound infection rates were higher as the BMI increases in TAH (P<.001) but not in TVH (P=.26), LAVH (P=1), or TLH (P=.48). CONCLUSION: As the BMI increases, the rate of TAH increases and the rates of TVH and LAVH decrease. Elevated BMI increases operative time in all subgroups and wound infection in the TAH group.