Impact of Obesity on Perioperative Complications in Prolapse Patients ≥70 Years Old

INTRODUCTION: Obesity is a chronic metabolic disorder associated with elevated body fat stores. Although the prevalence of obesity is lower in the elderly, an increasing number of individuals are expected to be both elderly and obese as the geriatric population grows. The impact of obesity on perioperative complications following reconstructive pelvic surgery in older women is unclear. OBJECTIVE: To determine the association between obesity and short-term perioperative adverse events (AEs) in women ≥70 years undergoing pelvic organ prolapse surgery. METHODS: We performed a secondary analysis of a retrospective cohort study of women undergoing prolapse surgery at two medical centers from January 2016 to May 2023. Patients ≥70 years were included, and those with missing body mass index (BMI) values were excluded. Women were categorized as either non-obese (BMI <30 kg/m2), class 1 obese (BMI 30–34.9 kg/m2), or class 2+ obese (BMI ≥35 kg/m2). The primary outcome was composite AEs. These included intraoperative complications and postoperative complications within 8 weeks of surgery, as delineated in Table 2. Secondary outcomes included individual AEs. Clinicodemographic variables and AEs were compared using one-way ANOVA (or Kruskal-Wallis) and chi-square (or Fisher’s exact) analyses. For the primary outcome and for individual AEs that differed significantly by obesity class, stepwise multivariable logistic regression with backward removal technique was performed using candidate variables p<0.10 on univariate regression (age, parity, preoperative prolapse stage, hypertension, diabetes, frailty status, history of prior hysterectomy, isolated colporrhaphy surgery type, and concomitant incontinence procedure). RESULTS: Of 1504 older women undergoing prolapse surgery, 20.9% (n=315) were Class 1 obese and 6.0% (n=90) were Class 2+ obese (Table 1). Obese patients were younger and more likely to have hypertension, diabetes, and be frail (p<0.01). Obese patients were more likely to have had a prior hysterectomy and to undergo isolated colporrhaphy without apical suspension (p=0.01). Class 2+ obese patients had greater EBL with surgery (median 75 mL (Class 2+) vs 50 mL (Class 1) vs 50 mL (non-obese), p=0.01). Obese patients were not more likely to receive perioperative thromboprophylaxis or be discharged with a course of postoperative thromboprophylaxis. AEs occurred to 27.5% (n=414) of the cohort. Obesity class was not associated with composite AEs (Table 2). However, hematomas were more frequent in Class 1 and 2+ obese patients (3.2% (Class 1) vs 5.6% (Class 2+) vs 1.2% (non-obese), p<0.01). There was no association between obesity class and composite AEs on multivariable logistic regression, but there was an association between postoperative hematoma and obesity class. Class 1 obese women had a 2.56 greater adjusted odds (95% CI 1.06–6.15) and Class 2+ obese women had a 4.82 greater adjusted odds (95% CI 1.63–14.3) of hematoma compared to non-obese women. CONCLUSIONS: Obesity in elderly surgical patients was not associated with a greater incidence of composite adverse events. However, moderate-severe obesity was associated with a 4.82 greater odds of postoperative hematoma. Further research is needed to better understand the clinical factors contributing to this association.