Impact of body mass index and operative approach on surgical morbidity and costs in women with endometrial carcinoma and hyperplasia

Objective To assess the impact of body mass index (BMI) and operative approach on surgical morbidity and costs in patients with endometrial carcinoma (EC) and hyperplasia (EH). Methods All women with BMI data who underwent surgery for EC or EH from 2008 to 2014 were identified from MarketScan, a healthcare claims database. Differences in 30-day complications and costs were compared between BMI groups and stratified by surgical modality. Results Of 1112 patients, 35%, 36%, and 29% had a BMI of ≤ 29, 30–39, and ≥ 40 kg/m², respectively. Compared to patients with a BMI of 30–39 and ≤ 29, women with a BMI ≥ 40 had higher rates of venous thromboembolism (3% vs 0.2% vs 0.3%, p < 0.01) and wound infection (7% vs 3% vs 3%, p = 0.02). This increase was driven by the subset of patients who had laparotomy and was not seen in those undergoing minimally invasive surgery (MIS). Median total costs for women with a BMI ≥ 40, 30–39, and ≤ 29 were U.S. $17.3 k, $16.8 k, and $16.6 k respectively (p = 0.53). Costs were higher for patients who had laparotomy than those who had MIS across all BMI groups, with the cost difference being highest in morbidly obese women (≥ 40: $21.6 k vs $14.9 k, p < 0.01; 30–39: $18.9 k vs $16.1 k, p = 0.01; ≤ 29: $19.3 k vs $15 k, p < 0.01). Patients who had complications had higher costs compared to those who did not, with a higher cost difference in the laparotomy group ($27.7 k vs $16.4 k, p < 0.01) compared to the MIS group ($19.9 k vs $15 k, p < 0.01). Conclusions MIS may increase the value of care by minimizing complications and decreasing costs. This may be most pronounced in morbidly obese women.