The relationship beteween vaginal, laparoscopic and abdominal surgical approaches and related complications
Cohort study of prospectively collected data
Patients undergoing hysterectomy for benign conditions
Data from the American College of Surgeons National Surgical Quality Improvement program database
Patient information | 30-day postoperative outcomes | Procedure-specific risk factors and outcomes in >100 of those participating hospitals
Patients were compared with respect to 30-day postoperative complications and uterine weight, stratified by surgical approach
27,167 patients were analyzed
Compared to women with uteri ≤100 g (and adjusted for medical and surgical variables) women with larger uteri had more complications
500g uteri: >30% more likely to have complications
Adjusted odds ratio (aOR) 1.34 (95% CI, 1.17–1.54; P < .0001)
750g uteri: ~60% more likely to have complications
aOR 1.58 (95% CI, 1.37–1.82; P < .0001)
≥1000g uteri: >80% more likely to have complications
aOR 1.85 (95% CI, 1.55–2.21; P < .0001)
The incidence of 30-day postsurgical complications
Abdominal hysterectomy: 15%
Laparoscopic hysterectomy: 8%
For each stratum of uterine weight abdominal hysterectomy had significantly higher odds of any complication compared to laparoscopic hysterectomy
<250g uteri: Abdominal hysterectomy had twice the odds of any complication
aOR 2.05 (95% CI, 1.80–2.33)
250–500g uteri: Abdominal hysterectomy was associated with an almost 80% increase in odds of any complication
aOR 1.76 (95% CI, 1.41–2.19)
>500g uteri: Abdominal hysterectomy was associated with >30% increased odds of any complication
aOR 1.35 (95% confidence interval, 1.07–1.71)
Uterine weight increased the risk for posthysterectomy complications as an independent variable
Abdominal hysterectomy had higher odds of any complication, compared to laparoscopic hysterectomy, even for enlarged uteri greater than 500g
The authors state
Our study suggests that uterine weight alone is not an appropriate indication for abdominal hysterectomy and that it is safe to perform larger hysterectomies laparoscopically. Patients may benefit from experienced surgeons who are able to offer minimally invasive approaches even for enlarged uteri.
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