Comparison of 30-Day Complication Rate Between Minimally Invasive Hysterectomy with and Without Concomitant Urogynecologic Procedure

• Published in: Journal of minimally invasive gynecology Vol. 26; no. 7; p. S88
• Main Authors: Griebel, L, Chapman, G, Mahajan, S, Billow, M, El-Nashar, S, Dizon, AM
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-11-2019
• ISSN: 1553-4650; 1553-4669
• DOI: 10.1016/j.jmig.2019.09.746

Primary objective was to evaluate risk of perioperative complications when performing concomitant urogynecologic surgery at time of minimally invasive hysterectomy for large uterus (>250gm).
Retrospective cohort study of existing national database. Patients were followed for complications 30 days after hysterectomy.
Data was extracted from the NSQIP database.
Patients were included who underwent laparoscopic or vaginal hysterectomy for benign indications with uterine weight of at least 250gm from 2014-2017. Patients with gynecologic malignancy and those who underwent abdominal hysterectomy were excluded. The total cohort included 7,428 patients.
We assessed the effect of concomitant urogynecologic procedure on 30 day complication rates after laparoscopic or vaginal hysterectomy for large uterus (>250gm).
Chi-square analysis and Student's t-test were used to describe the population and compare groups. Primary outcome was composite rate of all 30 day complications. Stepwise backward multivariate logistic regression was used to control for confounders of the primary outcome.
301 of the 7,428 total patients (4.1%) underwent concomitant urogynecologic procedures. This population was older (49.7 vs 46.6 years, p<0.001), had lower uterine weight (429.2g vs 489.5g, p<0.001), had lower BMI (30.5 vs 31.5, p=0.02), was more likely to be white, was more likely to have a urogynecologist involved, and was more likely to undergo vaginal hysterectomy. Groups were otherwise similar. With regard to primary outcome, the 30 day complication rate was higher in patients who underwent a concomitant urogynecologic procedure (13.3% vs 9.0%, p=0.02). After controlling for confounders including uterine weight, demographic and medical characteristics, operative time, hysterectomy route, and urogynecologic surgeon, concomitant urogynecologic procedure remained an independent predictor of complications (aOR 1.53, 1.07-2.18, p=0.02).
In this retrospective analysis of a large national cohort, the 30 day complication rate was greater than 50% higher when concomitant urogynecologic procedure was performed at the time of minimally invasive hysterectomy for a uterus >250gm.