BACKGROUND AND PURPOSE: 

• Laparoscopic hysterectomy is recognized as being associated with reduced complications and speedier recoveries  
• One of the reasons for still offering abdominal hysterectomy is enlarged uterus  
• Louie et al. (AJOG, 2018) sought to determine whether  
  • Whether uterine weight increases posthysterectomy complications
  • The relationship beteween vaginal, laparoscopic and abdominal surgical approaches and related complications

METHODS: 

• 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 

RESULTS: 

• 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)

CONCLUSION: 

• 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. 

Learn More – Primary Sources: 

Uterine weight and complications after abdominal, laparoscopic, and vaginal hysterectomy

Related ObG Topics:

Evidence-Based Gynecologic Surgery Best Practices: The AHRQ Safety Program

Mode of Gynecologic Surgery and Risk for Post-Op Venous Thromboembolism