Association of body mass index and length of stay in patients undergoing minimally invasive surgery for uterine cancer: a National Surgical Quality Improvement Program (NSQIP) study.

OBJECTIVE

Body mass index (BMI) has been associated with length of stay and post-operative complications; however, minimally invasive surgery has been proposed to mitigate this. Using real-world data of patients undergoing minimally invasive surgery for uterine cancer, we investigated the association between BMI and length of stay. Among patients discharged the same day, we explored post-operative complications associated with BMI.

METHODS

This was a National Surgical Quality Improvement Program retrospective cohort study including patients who underwent minimally invasive surgery for uterine cancer from 2013 to 2022. We performed a multi-variable Poisson regression to assess the association between BMI and length of stay, adjusting for a priori selected patient-level factors. In patients discharged the same day after surgery, we performed multi-variable linear regression to assess associations between BMI and the following post-operative complications: wound disruption, blood transfusion, surgical site infections, urinary tract infection, pneumonia, sepsis, deep vein thrombosis, pulmonary embolism, renal insufficiency, myocardial infarction, stroke/cerebrovascular accident, and re-admission, return to the operating room, and death within 30 days.

RESULTS

A total of 33,307 patients were included. Their median BMI was 34.2 kg/m2 (interquartile range [IQR] 12.88) and median length of stay was 1 day (IQR 1). Length of stay increased by approximately 0.5 hours per 5 kg/m2 (per BMI obesity class categorization). In total, 9186 patients (27.6%) were discharged the same day after their minimally invasive surgery for uterine cancer, and in this cohort, no association between BMI and any post-operative complications were found.

CONCLUSIONS

In patients undergoing minimally invasive surgery for uterine cancer, BMI was not associated with a clinically significant increase in length of stay, and in those discharged the same day, BMI was not associated with post-operative complications. Minimally invasive surgery for uterine cancer should be considered standard of care regardless of patient BMI, and same-day discharge for patients with elevated BMI is safe.