Impact of obesity on surgical outcomes following uterine-preserving apical prolapse repair: A retrospective cohort study.

OBJECTIVE Uterine preserving procedures for treatment of pelvic organ prolapse (POP) have been drawing increased interest in recent years. The aim of this study was to investigate the impact of obesity on outcomes following uterine preserving apical prolapse repair.

METHODS We performed a retrospective cohort study including women who underwent uterine-preserving apical prolapse repair between 2010 and 2024. The cohort was categorized into two groups based on body mass index (BMI): BMI ≤ 30 and BMI > 30. Outcome measures included subjective, anatomical, and composite outcomes as well as patient satisfaction.

RESULTS A total of 376 women were included; 316 (84.0%) with BMI ≤ 30 and 60 (16.0%) with BMI > 30. Mean BMI was 24.6 ± 2.6 in the non-obese group vs. 33.2 ± 3.5 in the obese group. Postoperative complications within 30 days after surgery were similar between groups (12.0% vs. 16.7%, p = 0.323, for the BMI ≤ 30 and > 30 groups, respectively). Subjective success rates were 89.5% vs. 90.6% (p = 0.811), and composite outcome success was 88.1% vs. 81.1% (p = 0.168) for the BMI ≤ 30 and > 30 groups, respectively. Anatomical success was significantly lower in the BMI > 30 group (81.1% vs. 94.0%, p = 0.004). On multivariate logistic regression, BMI > 30 and increased preoperative POP-Q Bp point were independently associated with increased risk of anatomical failure.

CONCLUSIONS Obesity was not associated with increased postoperative complications 30 days after surgery following uterine-preserving apical prolapse repair. However, anatomical success was significantly lower among women with BMI > 30. These findings should be interpreted cautiously given the unequal group sizes and heterogeneity of the cohort.