Introduction: This study compares intensive care unit outcomes between obese and non-obese postmenopausal women undergoing gastric surgery, a population vulnerable to distinct metabolic and respiratory risks. Ultimately, we aim to evaluate how obesity status influences postoperative ICU length of stay, complication rates, and resource utilization in these patients.

Material and methods: This descriptive cross-sectional study was conducted at Tabriz University of Medical Sciences during 2023 and included 215 postmenopausal women selected through convenience sampling. Sample size was estimated using the Cochran formula for a single-population proportion. The study assessed demographic, clinical, surgical, and ICU-related variables, including obesity status, comorbidities, operative characteristics, inflammatory markers, postoperative complications, and key intensive care outcomes.

Results: Obese postmenopausal women experienced significantly longer ICU stays (54.82 ± 14.63 vs. 38.15 ± 9.47 hours; p < 0.001) and prolonged mechanical ventilation (8.42 vs. 4.15 hours). Higher rates of respiratory distress (29.81% vs. 9.91%; p < 0.001) and wound infections (12.50% vs. 3.60%; p = 0.014) were observed. Consequently, obesity extended total hospitalization to 8.74 days compared to 6.82 days (p < 0.001), reflecting a more complex and resource-intensive postoperative recovery trajectory.

Conclusion: Obesity in postmenopausal women significantly impairs recovery after gastric surgery, leading to extended ICU stays and increased respiratory and infectious complications. These findings suggest that obese patients require more intensive perioperative management and specialized monitoring. Clinicians should prioritize early mobilization and targeted pulmonary interventions to mitigate the heightened resource utilization and clinical risks associated with elevated body mass in this population.