Does BMI Affect Choice in Apical Prolapse Repair Surgery?

Objectives: Obesity is a prevalent risk factor for developing pelvic organ prolapse. It is unknown whether the severity of obesity influences surgeon selection of type of surgery. This study aims to investigate whether obesity is an independent predictor of mode of apical prolapse surgery.

Methods: This is a secondary analysis of a retrospective cohort study assessing the relationship between mode of apical prolapse surgery and socioeconomic identifiers. Patients were eligible if they underwent an apical prolapse surgery within Kaiser Permanente Southern California (KPSC) medical facilities between 2014 and 2017. Patient demographic information, comorbidities, medical and surgical variables were retrospectively abstracted from the medical record. Multivariate logistic regression analysis was used to determine whether body mass index (BMI) is associated with mode of apical prolapse surgery.

Results: During the study period, 4,250 patients across 19 regional medical centers underwent apical pelvic organ prolapse surgery. Within this sample, prolapse stage was unable to be extracted for 702 patients, therefore 3,548 patients were included in the final analysis. There was no significant difference in the BMI of patients undergoing sacrocolpopexies versus vaginal tissue repair. Overweight patients with BMIs between 25 and 29 were the most common for both sacrocolpopexies and vaginal tissue repairs. When further separated into sacrocolpopexy, vaginal suspension, sacrospinous fixation, colpocleisis, and laparoscopy, there were also no significant differences in the BMIs of the patients.

Conclusions: BMI is not an independent predictor of choice of apical prolapse repair when controlling for other factors including stage of prolapse. The number of patients with morbid obesity was limited in this study. Further research is needed to evaluate surgical mode at extremes of BMI.