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Body mass index influences the risk of reoperation after first-time surgery for pelvic organ prolapse. A Danish cohort study, 2010–2016

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Abstract

Introduction and hypothesis

The aims of this study were to evaluate the impact of body mass index (BMI) on the risk of reoperation for pelvic organ prolapse (POP) up to 5 years after first-time surgery.

Materials and methods

This nationwide register-based study includes first-time POP surgery in 2010 through 2016. The cumulative incidence proportions of reoperation were analyzed in a Cox regression model and described using Kaplan-Meier plots stratified in BMI categories.

Results

A total of 28,533 first-time procedures were performed in 22,624 women; 76.6% had single-compartment repair. The 1- and 5-year reoperation rate within the same compartment was 2.6% and 6.1% respectively for women with BMI < 25, and for women with BMI > 35 it was 3.7% and 11.2 respectively. In the anterior compartment there was a significantly increased adjusted hazard ratio for reoperation in the same compartment with increasing BMI (reference group BMI < 25), BMI 30–34.9 with an aHR = 1.34 (CI 95% 1.04–1.71) and BMI ≥ 35 aHR = 1.77 (CI 95% 1.17–2.67). The 1- and 5-year reoperation rate in an adjacent compartment was 0.6% and 1.6% respectively for women with BMI < 25, and for women with BMI > 35 it was 1.0% and 4.4 respectively. For reoperation in an adjacent compartment the adjusted results were BMI 30–34.9 aHR = 1.64 (95% CI 1.05–2.56) and BMI > 35 aHR = 2.64 (95% CI 1.36–5.14) when the first-time operation was in the anterior compartment.

Conclusions

If the woman had BMI > 35 and first-time surgery was in the anterior compartment, she had an almost doubled risk of reoperation within 5 years both in the same compartment and in an adjacent compartment compared to women with BMI < 35. In the apical and posterior compartment there was a trend towards increasing risk of reoperation with increasing BMI, although with a broad confidence interval.

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Acknowledgements

The study was supported by the Program for Clinical Research Infrastructure (PROCRIN) established by the Lundbeck Foundation and the Novo Nordisk Foundation.

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Herlev University Hospital, Borgmester Ib Juuls vej 21, DK 2730, Herlev, Denmark

    Vibeke Weltz & Gunnar Lose

  2. Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark

    Rikke Guldberg

  3. Center for Clinical Epidemiology, Odense University Hospital, Denmark and Department of Clinical and Molecular Medicine Norwegian University of Science and Technology, Trondheim, Norway

    Michael Due Larsen

Authors
  1. Vibeke Weltz
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  2. Rikke Guldberg
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  3. Michael Due Larsen
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  4. Gunnar Lose
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Contributions

All authors have contributed to the project conception. All analyses were performed by MD Larsen. The manuscript was drafted by V Weltz and R Guldberg. All authors have contributed substantively to interpretation of the study results, development of the manuscript and approved the final submitted version of the manuscript.

Corresponding author

Correspondence to Vibeke Weltz.

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Conflict of interest

V Weltz, G Lose and MD Larsen have no conflicts of interest to declare. R Guldberg has been a member of Advisory Board for Astellas and has received payment for tuition.

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Appendix

Appendix

Anterior repairs:

KLEF00 = Anterior colporrhaphy

KLEF00A = Anterior colporrhaphy with mesh

KLEF60 = Vaginal lateral colporrhaphy

KLEF63 = Abdomial lateral colporrhaphy

KLEF64 = Laparoscopic lateral colporrhaphy

Apical repairs:

KLEF23 = Complete colpocleisis

KLEF50 = Abdominal apical colpopexy after previous hysterectomy

KLEF50A = Abdominal apical colpopexy after previous hysterectomy with mesh

KLEF51 = Laparoscopic apical colpopexy after previous hysterectomy

KLEF51A = Laparoscopic apical colpopexy after previous hysterectomy with mesh

KLEF53 = Vaginal apical colpopexy after previous hysterectomy

KLEF53A = Vaginal apical colpopexy after previous hysterectomy with mesh

KLEF53B = Vaginal apical colpopexy, sacrospinous ligament

Posterior repairs:

KLEF03 = Posterior vaginal apical colporrhaphy the sacrospineous ligament

KLEF03A = Posterior vaginal apical colporrhaphy with mesh

KLEF40 = Vaginal operation for enterocele

KLEF40A = Vaginal operation for enterocele with mesh

KLEF41 = Laparoscopic operation for enterocele

KLEF41A = Laparoscopic operation for enterocele with mesh

KLEF43 = Abdominal operation for enterocele

KLEF43A = Abdominal operation for enterocele with mesh

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Weltz, V., Guldberg, R., Larsen, M.D. et al. Body mass index influences the risk of reoperation after first-time surgery for pelvic organ prolapse. A Danish cohort study, 2010–2016. Int Urogynecol J 32, 801–808 (2021). https://doi.org/10.1007/s00192-020-04482-3

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