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Maternal obesity associated with clinically increased blood loss and postoperative hospital stay in patients undergoing peripartum hysterectomy
Abstract Number: S 10
Abstract Type: Original Research
Background: The incidence of peripartum hysterectomy has increased alarmingly over the last 2 decades, and carries multiple maternal risks as an innately complex surgery. Recent CDC data demonstrates that greater than 1/3 of the U.S. population is obese (BMI ≥ 30), and numerous studies have documented the increased risks of obesity during pregnancy. We sought to investigate if obesity is associated with perioperative complications in women undergoing peripartum hysterectomy.
Methods: Utilizing ICD-9 codes, we queried patients who underwent a peripartum hysterectomy from 2007 to 2012 at Abbott Northwestern Hospital in Minneapolis, MN. We categorized these patients into obese (BMI ≥30) and non-obese (BMI <30) cohorts. Our primary outcomes of interest included surgical and postoperative complications and estimated blood loss. Secondary outcomes recorded included transfusion of ≥4 units of blood, number of postoperative hospital days, and readmission. Surgical complications were defined as any type of ureteral injury, intentional or unintentional cystotomy, other damage to surrounding organs, and complications from interventional radiologic procedures. Postoperative complications included respiratory failure (defined as the inability to immediately extubate after surgery), pulmonary embolism or other thrombotic events, renal failure, requirement for additional procedures, post-operative ileus, bowel obstruction, ARDS, sepsis, infection, and febrile illness.
Results: We identified 63 patients during the 5 year time period who underwent peripartum hysterectomy. We excluded 3 patients who were outliers due to previable pregnancy and excessive blood loss (defined as greater than 20L), leaving 60 cases for analysis. We found that there was an increased EBL (4131 mL vs 3094 mL; p=0.11) and a longer hospital stay (6 days vs 5.1 days; p=0.16) among obese patients vs non-obese patients undergoing peripartum hysterectomy. Although not reaching statistical significance, this difference is clinically important.
Conclusion: Obese patients undergoing peripartum hysterectomy experience clinically increased blood loss intra-operatively and necessitate a longer postoperative hospital stay. Additional research to further explore this unique patient population is necessary.