Dr. Kisby on obesity in patients undergoing prolapse surgery

In this video, Cassandra K. Kisby, MD, MS, shares the background and notable findings from the Urogynecology study “Impact of Severe Obesity on Major Perioperative Complications for Prolapse Surgery.” Kisby is an assistant professor of obstetrics and gynecology, obstetrics and gynecology, and urogynecology at Duke University in Durham, North Carolina.

Transcription:

Please describe the background for this study.

We have an increasing body of literature on surgical outcomes for patients with pelvic organ prolapse, including data on vaginal or native tissue procedures as well as laparoscopic and robotic procedures for prolapse. I think it's important to also take a step back and not only look at outcomes, but also look at safety of these procedures, particularly in a changing population. There are 2 major changes happening in our patient population. One is the overall size of the elderly population. This is growing, and we know that prolapse is most common in patients over age 60. The other concurrent trend that's happening is also the number of patients with an elevated body mass index or BMI. We don't have a lot of good data about BMI in patients undergoing prolapse surgery. The data that we do have that does exist in literature oftentimes uses the WHO definition for obesity, which is a BMI of 30. Clinically, I really noticed a difference in surgical morbidity once we're looking more at BMIs around the 40 range or even higher. That's where this study came from; I wanted to know where the inflection point was for BMI and surgical or perioperative complications. I was also curious if there was a difference between vaginal approaches to prolapse surgery vs laparoscopic and robotic approaches to surgery. To answer this question, we used a large national database that many people are familiar with—the NSQIP database. This looks at 30-day major complications or morbidity around surgery. And so we looked at major complications in particular, so things like surgical site infection, sepsis, VTE, acute renal injury, and things like that.

What were some of the notable findings? Were any of them surprising to you and your coauthors?

The most important thing that I think came out of this study is really the BMI inflection point for complications. We saw an abrupt rise in complications around a BMI of 40. This makes sense; things like cardiac morbidity and difficulty ventilating a patient, the risk of comorbid conditions like hypertension and diabetes, are pretty common among [patients with] higher BMIs. Using that inflection point, we found that the odds of a major complication were 1.8 times higher for women with a higher BMI, so women with a BMI over 40. And then we looked between surgical approaches. Women who underwent a laparoscopic or robotic approach to surgery were 6 times more likely to have a major complication, and that was the really big surprise for us. We didn't expect it to be such a big difference.

This transcription was edited for clarity.