Peri- and postoperative management and outcomes of morbidly obese patients (BMI > 40 kg/m2) with gynaecological disease
For the last two decades, obesity rates have been increasing in both developed and developing countries, with the number of obese women roughly doubling during this period (Stevens et al. in Popul Health Metr 10(1):33, 2012). Obesity represents one of the biggest epidemics of the 21st century. The aim of this retrospective study is to characterise the outcomes of gynaecologic surgeries in cases of extremely obese women with a body mass index (BMI) over 40 kg/m2.
This study is a retrospective case control study in a single-centre setting. Our clinical database was searched for gynaecological operations performed on morbidly obese patients (BMI > 40 kg/m2) between 2009 and 2014 in the Department of Gynaecology and Obstetrics at Hannover Medical School. We matched these results with random patients of normal body weight who had similar surgical procedures and diseases.
We included 97 obese patients in our case group and 99 patients in the control group. We found an association between a strongly elevated BMI and peri- and postoperative morbidity. Both intraoperative and postoperative complications are significantly increased in morbid obesity with a BMI over > 40 kg/m2. We observed intraoperative complications in 55.6% and postoperative complications in 50.5% of patients with extreme obesity. In contrast, the complication rate in the control group with a normal BMI was 11% intraoperatively (p = 0.0001) and 3% postoperatively (p = 0.0001). The data showed that perioperative and postoperative morbidity could be reduced by laparoscopic surgery in many cases, with a significant lower rate of difficulties with closing the wound, a significant shorter duration of surgery and a significant lower rate of infections combined with a significant lower reoperation rate and shorter hospital stay. In gynaecological–oncological diseases, we could demonstrate a reduced radicality during the operative procedure due to extreme obesity.
Dealing with the growing number of obese patients is essential, because the problems emerging from obesity are manifold for the treating hospitals as well as the general health system. For this high-risk patient group, it is indispensable to obtain a thorough overview of the patient’s overall situation preoperatively to ensure good perioperative care and complications management.
KeywordsGynecology Obesity Surgery Morbidity
SK: Project development, Manuscript writing. HK: Data collection. HH: Data analysis. PH: Data management. IS: Protocol development. CS: Manuscript editing. PS: Project development, manuscript editing.
Compliance with ethical standards
Conflict of interest
We declare that we have no conflict of interest
- 3.Statistisches Bundesamt (2010) Mikrozensus 2009—Fragen zur Gesundheit. Körpermaße der Bevölkerung, WiesbadenGoogle Scholar
- 4.The NHS Information Centre for Health and Social Care. Health survey for England—2010: Respiratory health, 2011. http://www.ic.nhs.uk/pubs/hse10report. Accessed 30 Aug 2012
- 5.Knoll KP, Hauner H (2008) Kosten der Adipositas in der Bundesrepublik Deutschland. Eine aktuelle Krankheitskostenstudie Adipositas 2(Heft 4):204–210Google Scholar
- 6.http://easo.org/perception-survey. Accessed 2017 Feb 15
- 10.Kaaks R, Lukanova A, Kurzer MA (2002) Obesity, endogenous hormones, and endometrial cancer risk: a systematic review. Cancer Epidemiol Biomark Prev 11:1531–1543Google Scholar
- 23.Samulak D, Michalska M, Wilcak M, Pieta B, Sajdak S (2010) Vaginal hysterectomy aided with surgery by the abdominal approach as a method of hysterectomy with salpingo-oophorectomy due to endometrial carcinoma in a woman with morbid obesity. Case report. Eur J Gynaecol Oncol 31(4):475–477PubMedGoogle Scholar
- 28.Doll KM, Kalinowski AK, Snavely AC, Irwin DE, Bensen JT, Bae-Jump VL, Kim KH, Van Le L, Clarke-Pearson DL, Gehrig PA (2015) Obesity is associated with worse quality of life in women with gynecologic malignancies: an opportunity to improve patient-centered outcomes. Cancer 121(3):395–402CrossRefPubMedGoogle Scholar
- 40.Savage MW, Pottinger JM, Chiang HY, Yohnke KR, Bowdler NC, Herwaldt LA (2013) Surgical site infections and cellulitis after abdominal hysterectomy. Am J Obstet Gynecol 209:108.e1–108.10.8Google Scholar
- 44.Parkin L, Sweetland S, Balkwill A, Green J, Reeves G, Beral V (2012) Body mass index, surgery and risk of venous thromboembolism in middle-age women: a cohort study. Million Women Study Collaborators. Circulation 125:1897–1907, 1897–1904Google Scholar