INTRODUCTION: Obesity has long been cited as a risk factor associated with increased postoperative morbidity in various surgical fields. This study looks at obesity as an independent risk factor for peri- and postoperative morbidity among patients undergoing midurethral sling (MUS) placement for stress urinary incontinence (SUI). OBJECTIVE: The objective of this analysis was to compare the association of obesity use on 30-day perioperative complications after MUS placement for SUI. METHODS: This was a retrospective database analysis of the National Surgical Quality Improvement Program (NSQIP) database for the years 2015 through 2021. Cases were selected using International Classification of Diseases (ICD-10) codes that reflected diagnosis codes for SUI (N39.3) and with Current Procedural Terminology (CPT) codes 57288 for MUS. Obesity was categorized into four groups: non-obese (BMI 18.5−29.9 kg/m 2), obese class I (BMI 30−34.9 kg/m2), obese class II (BMI 35−39.9 kg/m2), and obese class III (BMI ≥40 kg/m2). Chi-square tests, independent t-tests, and Mann–Whitney U tests were used to compare major and minor complication rates groups with non-obese patients as a reference group. Regression analysis was used to assess the role of patient and operative factors in complication rates. A p-value of <0.05 was used to determine significance. RESULTS: 25,555 cases were identified, of which 13,151 were non-obese (51.5%), 6,316 were classified as class I obesity (24.7%), 3,421 as class II obesity (13.4%), and 2,252 as class III obesity (8.8%). Obese individuals were more likely to have preoperative COPD (3.5% vs 2.3%, p<0.001), HTN requiring medication (41.4% vs 26.9%, p<0.001), diabetes (16.2% vs 7.2%, p<0.001), and identify as a current smoker (14.5% vs 10.6%, p<0.01). Obese individuals were noted to have a higher rate of postoperative UTI (4.3% vs 3.8% p=0.48), superficial surgical site infection (0.7% vs 0.4%, p<0.001), and transfusions for bleeding (0.3% vs 0.1%, p=0.05). Reoperation rates were slightly higher amongst non-obese individuals (1.3% vs 1.0%, p=0.47); otherwise, no differences were noted in readmission rates. Obesity was not associated with increased odds of 30-day postoperative complications when controlling for age, smoking status, COPD, HTN, diabetes, total operative time or ASA classification. CONCLUSIONS: Obesity was associated with increased rate of UTI, superficial surgical site infection and need for postoperative blood transfusion. These findings can help further guide preoperative counseling to optimize patient outcomes after surgery.Table 1
Arora et al. (Fri,) studied this question.