Design: A cohort study of prospectively collected data.

Setting: American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2012 – 2020.

Patients or Participants: Patients with uterine fibroids undergoing myomectomy.

Interventions: We analyzed major and minor complications according to BMI for patients who underwent myomectomy.

Measurements and Main Results:

A total of 29,305 cases were included. Postoperative complications occurred in 11.0% of cases (n=3,230), ranging from 9.2% among underweight patients to 15.5% among patients with obesity class 3 (p<0.001).

In multivariable regression analysis, patients with obesity class 2 and 3 experienced more any postoperative complications (aOR 1.18 and 1.28, respectively), and minor (aOR 1.02 and 1.12, respectively), compared to patients with normal BMI. The odds of major complications were lower (aOR 0.71) for patients with obesity class 1 and higher for patients with obesity class 3 (aOR 1.46) compared to normal BMI.

Patients with obesity class 3 experienced more complications (aOR 1.27), both minor (aOR 1.21) and major (aOR 1.60), compared to the other BMI classes combined.

When examining abdominal myomectomies only, compared to normal weight, patients with obesity class 2 and 3 experienced more complications compared to patients with normal BMI. Complications did not differ based on BMI when restricting the cohort to minimally invasive myomectomy, except for higher odds of minor complications among patients with obesity class 3.

Conclusion: Class 3 obese patients are at increased odds for experiencing complications following myomectomy, whereas being slightly obese appears to be protective. These differences based on BMI are largely driven by complications experienced following abdominal, rather than minimally invasive, myomectomy.