The impact of body mass index on surgical complications in minimally invasive hysterectomy for uterine fibroids

•Higher BMI was associated with fewer major complications in MIH for fibroids.•BMI is not associated with any complication rates in MIH for fibroids.•Operative time increases with BMI in MIH for fibroid treatment.•Findings support BMI-based planning for MIH in fibroid cases. We aimed to assess the impact of Body Mass Index (BMI) on 30-day postoperative complications in patients undergoing minimally invasive hysterectomy (MIH) for fibroids. Using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2012–2020), we analyzed major and minor 30-day postoperative complications, stratified by BMI, in patients with uterine fibroids who underwent MIH. Complications were stratified according to the Clavien-Dindo classification. Among 61,192 patients, overall complication rates ranged from 6.3 % to 8.1 %, with the highest rates in obesity class 3. Significant differences were observed in minor complication rates across BMI groups, though major complication rates did not significantly vary. Higher BMI classes correlated with longer operative times, with mean durations ranging from 127.1 min in the lowest BMI group to 158.1 min in the highest BMI group (p