Background

Body mass index (BMI) is a known risk factor for increased adverse events post-hysterectomy. The effects of previous bariatric surgery on outcomes after inpatient hysterectomy are not well elucidated.

Methods

The 2016 to 2018 National Inpatient Sample was queried for patients who underwent hysterectomy with International Classification of Disease-10 (ICD-10) codes. In an unmatched analysis, logistic regression was used to assess risk factors for post-hysterectomy complications, including infections, thromboembolic events, genitourinary injury, vaginal vault prolapse, and wound disruptions. Patients in the bariatric surgery and control groups (no bariatric surgery history) were then matched 1:2 by age, Elixhauser comorbidity score, and BMI to analyze the risk of complications, length of stay, and total charges.

Results

In the unmatched analysis (N=20,880), when compared to women with BMI 20-29.9, patients with BMI >= 40 (N=10,372) had higher odds of inpatient post hysterectomy complications (abdominal wall infection, urinary tract infection and wound disruption), while patients with BMI 30-39.9 (N=10,508) or those with a past bariatric surgery (N=1,439) did not (Table 1). When 1:2 case-control matching was performed, women with a history of bariatric surgery (N=595) had significantly fewer complications, decreased average length of stay, and decreased total charges than the control group (N=1,190) (Figure 1).

Conclusions

When matched for age, BMI, and comorbidity score, patients with previous bariatric surgery had fewer complications, length of stay and total charges. Women with BMI >= 40 requiring non-urgent hysterectomy may benefit from undergoing bariatric surgery first.