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 endometriosis undergoing MIH.

Interventions: Minimally invasive hysterectomy.

Measurements and Main Results:

Patients who underwent MIH for endometriosis were classified into BMI subgroups based on the WHO classification system. Postoperative minor and major complications occurring within 30 days, defined according to the Clavien-Dindo classification, were compared across the BMI subgroups.

A total of 6768 patients were included in the cohort. Higher BMI classes were associated with longer operative times (range 119.0-146.2 minutes, p<0.001).

There was no statistically significant difference between BMI groups in the rates of any, major or minor complications. The rate of any complications ranged 4.6%-8.9% between groups. Major complication rates ranged 2.3%-4.1% and minor complication rates 2.3%-6.6%.

In multivariable regression analysis comparing low and high BMI groups, BMI was not independently associated with increased complication rates.

In multivariable regression analysis comparing BMI subgroups, obesity class 2 was associated with lower odds of minor complications compared to the normal BMI group [adjusted odds ratio 95% confidence interval 0.67 (0.45-0.99)]. Other BMI categories were not independently associated with any, minor, or major complications compared to the normal BMI category.

Conclusion: After adjusting for confounding factors, the odds of most postoperative complications were independent of BMI categories. This is contrary to previous reports associating increased BMI with increased complication rates. These findings can help counsel and prepare patients for surgery.