Objective: To compare outcomes and complications after sacrocolpopexy (SC) performed with and without Burch colposuspension between obese and healthy-weight women.
Methods: Baseline and up to 2-year postoperative data were analyzed in 322 women in the Colpopexy And Urinary Reduction Efforts (CARE) study, a randomized trial of SC with or without Burch colposuspension in stress continent women with Stages II–IV prolapse. Participants completed a medical history, Pelvic Organ Prolapse Quantification (POP-Q), cough stress test and quality-of-life (QOL) questionnaires (Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and SF-36 Mental and Physical Component Summary Scores (MCS and PCS)) at baseline and postoperative visits. Baseline body mass index (BMI) was used to define weight groups: obese (≥ 30 kg/m2), overweight (25-29.9 kg/m2), healthy weight (18.5-24.9 kg/m2) and underweight (< 18.5 kg/m2). Baseline measures, 2-year surgical outcomes, operative variables and complication rates were compared between obese and healthy-weight women using Mantel Haenszel and Wilcoxon tests. Analyses of postoperative variables were adjusted for age and randomization assignment (Burch or no Burch) (all), prior urinary incontinence (UI) or prolapse surgery (UI outcomes) and baseline POP-Q Stage (prolapse outcomes).
Results: Participants included 74 (23.0%) obese, 122 (37.9%) overweight, and 125 (38.8%) healthy-weight women and 1 (0.3%) underweight woman. Compared to healthy-weight women, the obese women were younger (59.0 ± 9.9 vs. 62.1 ± 10.3 years, p = 0.04), more likely to report diabetes (10.8% vs. 1.6%, p = 0.004), and more likely to have stage II (rather than stages III or IV) prolapse (25.7% vs. 11.2%, p = 0.01). At baseline, the obese group had more colo-rectal symptoms and related functional impact (Colorectal-anal Distress Inventory and Colorectal-anal Impact Questionnaire scores (median (interquartile range)): 67.6 (21.4, 144.4) vs. 40.5 [14.3, 92.9], p = 0.01; and 9.4 [0, 81.9] vs. 0 [0, 18.4], p < 0.001, respectively) and poorer general physical QOL (SF-36 PCS = 41.4 (36.0, 49.4) vs. 50.7 [42.3, 54.9], p < 0.0001). Two years after surgery, rates of stress UI and POP-Q stage did not differ between the obese and healthy-weight women. Rates of symptom resolution and satisfaction with the surgery also did not differ between the groups. In obese compared to healthy-weight women, operative time was longer (189 ± 52 vs. 169 ± 58 min, p = 0.02). Blood loss, hospital length of stay and other immediate postoperative complications, including wound problems, did not differ between the groups. The numbers of serious adverse events (SAE) classified as plausibly related to the index surgery did not differ in obese (13 [10.4%]) compared to healthy-weight women (10 [13.5%]).
Conclusion: Most outcomes after SC are similar in obese and healthy-weight women, including prolapse and UI measures, resolution of symptoms and satisfaction. Operative time is slightly longer in obese women.
KEYWORDS: Sacrocolpopexy, obesity, pelvic organ prolapse, overweight, urinary incontinence