7879 Complication Rates Following Total Laparoscopic Vs. Vaginal Hysterectomy in Patients with BMI ≥ 50 Kg/m2

Study Objective To determine which minimally invasive hysterectomy (MIH) route is associated with the lowest risk of complication in women with BMI ≥ 50 kg/m2. Design Retrospective cohort study utilizing the National Surgical Quality Improvement Program (NSQIP) database. Setting NSQIP participating institutions. Patients or Participants 5570 women with BMI ≥ 50 kg/m2 undergoing MIH from 2014 through 2020. Interventions Total laparoscopic (TLH) or vaginal hysterectomy (TVH) for uterus ≤ 250 g. Measurements and Main Results 481 patients underwent TVH, and 5089 women underwent TLH. Women who underwent TLH were significantly older (median age 51 vs. 46 years, p<0.01), and were more likely to identify as White race (77% vs. 67%, p<0.01), have hypertension (58% vs. 47%, p<0.01), and have an ASA class ≥ III (87% vs. 73%, p<0.001). Of patients who underwent TLH, 459/5089 (9%) experienced one or more complication within 30 days of surgery compared to 44/481 (9%) of women who underwent TVH (p=0.93). Median operative time was significantly longer for patients undergoing TLH (137 vs. 105 minutes, p<0.01), and median length of hospital stay (LOS) was identical (1 day, p=0.09). Patients undergoing TLH were more likely to develop superficial surgical site infections (SSI) (2% vs. 0%, p<0.01) but less likely to require transfusion (1% vs. 3%, p<0.01). The rates of all other individual complications were similar between the two groups. In multivariable regression modeling adjusted for potential confounding covariates, we did not observe significant evidence that vaginal as compared to laparoscopic hysterectomy was associated with increased odds of complication (aOR 1.1, 95% CI 0.8-1.5, p=0.7). Conclusion Patients with BMI ≥ 50 kg/m2 experienced hysterectomy-related complications at a higher rate than published in the general population, but the overall complications rates were similar between those undergoing TVH and TLH. In the carefully selected patient and with the appropriate surgeon skill set, both approaches are feasible for hysterectomy of the very obese patient. To determine which minimally invasive hysterectomy (MIH) route is associated with the lowest risk of complication in women with BMI ≥ 50 kg/m2. Retrospective cohort study utilizing the National Surgical Quality Improvement Program (NSQIP) database. NSQIP participating institutions. 5570 women with BMI ≥ 50 kg/m2 undergoing MIH from 2014 through 2020. Total laparoscopic (TLH) or vaginal hysterectomy (TVH) for uterus ≤ 250 g. 481 patients underwent TVH, and 5089 women underwent TLH. Women who underwent TLH were significantly older (median age 51 vs. 46 years, p<0.01), and were more likely to identify as White race (77% vs. 67%, p<0.01), have hypertension (58% vs. 47%, p<0.01), and have an ASA class ≥ III (87% vs. 73%, p<0.001). Of patients who underwent TLH, 459/5089 (9%) experienced one or more complication within 30 days of surgery compared to 44/481 (9%) of women who underwent TVH (p=0.93). Median operative time was significantly longer for patients undergoing TLH (137 vs. 105 minutes, p<0.01), and median length of hospital stay (LOS) was identical (1 day, p=0.09). Patients undergoing TLH were more likely to develop superficial surgical site infections (SSI) (2% vs. 0%, p<0.01) but less likely to require transfusion (1% vs. 3%, p<0.01). The rates of all other individual complications were similar between the two groups. In multivariable regression modeling adjusted for potential confounding covariates, we did not observe significant evidence that vaginal as compared to laparoscopic hysterectomy was associated with increased odds of complication (aOR 1.1, 95% CI 0.8-1.5, p=0.7). Patients with BMI ≥ 50 kg/m2 experienced hysterectomy-related complications at a higher rate than published in the general population, but the overall complications rates were similar between those undergoing TVH and TLH. In the carefully selected patient and with the appropriate surgeon skill set, both approaches are feasible for hysterectomy of the very obese patient.