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373 Outcomes of obese patients undergoing gynecologic surgery on an enhanced recovery after surgery (ERAS) program
  1. R Harrison1,
  2. MD Iniesta1,
  3. K Cain2,
  4. A Siverand1,
  5. B Pitcher3,
  6. J Lasala4,
  7. PT Ramirez1 and
  8. LA Meyer1
  1. 1University of Texas MD Anderson Cancer Center, Gynecologic Oncology and Reproductive Medicine, Houston, USA
  2. 2University of Texas MD Anderson Cancer Center, Pharmacy, Houston, USA
  3. 3University of Texas MD Anderson Cancer Center, Biostatistics, Houston, USA
  4. 4University of Texas MD Anderson Cancer Center, Anesthesiology and Perioperative Medicine, Houston, USA


Objectives To compare perioperative outcomes of obese vs. non-obese patients undergoing gynecologic surgery on an ERAS program.

Methods We retrospectively reviewed patients undergoing open surgery 11/2014–11/2018. Patients were classified into three categories based on body mass index (BMI) and obesity class:: normal/overweight [BMI 18.0–29.9 kg/m2], class I [BMI 30.0–34.9 kg/m2], class II [BMI 35.0–39.9 kg/m2], and class III or greater [BMI ≥40.0 kg/m2]. Obese patients were matched to non-obese patients by age, procedure date, and surgical indication. Standard statistical methods were utilized. Primary outcome was postoperative length of stay [LOS].

Results After matching, 696 patients were included in the analysis [normal/overweight, n=348; class I, n=163 class II, n=88; class III or greater, n=97]. All groups had a median postoperative LOS of 3 days. Obese patients had longer procedure times [median OR time: 218 min vs. 192.5 min, p<0.001] and greater estimated blood loss [median EBL: 300 mL vs. 200 mL, p<0.001]. Compliance with individual program elements was not different overall [70.1% vs. 69.8%, p=0.3262], although lower early mobilization was observed among obese patients [89.9% vs. 94.5%, p=0.023]. No differences were observed in severe [grade III-IV] perioperative complications [10.9% vs. 6.6%, p=0.06], reoperation [2.3% vs. 1.4%, p=0.577], and readmission [11.8% vs. 8.0%, p=0.128]. Mild complications [grade I-II] were more frequent in obese patients [62.4% vs. 48.3%, p<0.001], influenced by more wound complications in this group [4.9% vs. 17.8%, p<0.001].

Conclusions Even after longer operative time and greater blood loss, obese ERAS patients had comparable compliance, perioperative complications, and length of stay to non-obese patients.

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