The impact of body mass index on the risk of postoperative complications following myomectomy

Michal Axelrod; Kacey M Hamilton; Rebecca J Schneyer; Gabriel Levin; Yotam Weiss; Mireille D Truong; Kelly N Wright; Matthew T Siedhoff; Raanan Meyer

doi:10.1016/j.ajog.2024.10.038

The impact of body mass index on the risk of postoperative complications following myomectomy

Am J Obstet Gynecol. 2024 Nov 7:S0002-9378(24)01108-6. doi: 10.1016/j.ajog.2024.10.038. Online ahead of print.

Authors

Michal Axelrod¹, Kacey M Hamilton², Rebecca J Schneyer², Gabriel Levin³, Yotam Weiss⁴, Mireille D Truong², Kelly N Wright², Matthew T Siedhoff², Raanan Meyer²

Affiliations

¹ Josef Buchmann Gynecology and Maternity Center, Sheba Medical Center, Tel Hashomer, Israel; Tel Aviv University School of Medicine, Tel Aviv, Israel. Electronic address: michalaxelrod2805@gmail.com.
² Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA.
³ Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Quebec, Canada; The Department of Gynecologic Oncology, Hadassah Medical center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
⁴ Tel Aviv University School of Medicine, Tel Aviv, Israel; Division of Anesthesia, Intensive Care, and Pain Management, Tel Aviv Medical Center, Tel Aviv, Israel.

PMID: 39521303
DOI: 10.1016/j.ajog.2024.10.038

Abstract

Background: Uterine leiomyomas are common benign neoplasms, often causing symptoms like abnormal uterine bleeding, pelvic pain, and subfertility, with treatment options ranging from medical management to surgical interventions such as myomectomy. While myomectomy is effective in symptom relief, the impact of body mass index (BMI) on postoperative complications remains underexplored, warranting further investigation.

Objective: This study aimed to assess the relationship between BMI and short-term postoperative complications after myomectomy.

Study design: An analysis of major and minor 30-day postoperative complications stratified by BMI among patients who underwent abdominal or laparoscopic (conventional or robotic-assisted) myomectomy was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2020. Vaginal myomectomy cases were excluded from this study. Complications were stratified according to the Clavien-Dindo classification.

Results: A total of 27,387 cases were included. Postoperative complications occurred in 11.4% of cases (n=3131), ranging from 9.4% among patients who were underweight (n=26) to 16.1% among patients with obesity class 3 (n=350) (P<.001). In multiple regression analysis, patients with obesity class 1 experienced fewer major postoperative complications (adjusted odds ratio, 0.71; 95% confidence interval, 0.53-0.96) than those with normal BMI. Conversely, patients with obesity class 2 demonstrated more complications (adjusted odds ratio, 1.18; 95% confidence interval, 1.03-1.35), including minor complications (adjusted odds ratio, 1.17; 95% confidence interval, 1.02-1.34), than those with normal BMI. In addition, patients with obesity class 3 demonstrated more complications (adjusted odds ratio, 1.26; 95% confidence interval, 1.08-1.47), including minor (adjusted odds ratio, 1.21; 95% confidence interval, 1.03-1.42) and major (adjusted odds ratio, 1.41; 95% confidence interval, 1.01-21.99) complications, than those with normal BMI. Similar outcomes were observed when analyzing abdominal myomectomy exclusively, with disparities being much less pronounced when the analysis was confined to laparoscopic myomectomy.

Conclusion: Patients with class 2 or 3 obesity are at increased odds of experiencing complications after myomectomy, whereas those with a slightly elevated body mass index may experience a protective effect. Complications related to BMI predominantly manifest after abdominal myomectomy procedures rather than after laparoscopic approaches.

Keywords: abdominal myomectomy; body mass index; laparoscopic myomectomy; minimally invasive surgery; myoma; myomectomy; postoperative complications; uterine fibroids.