J Minim Invasive Gynecol. 2021 Oct 2:S1553-4650(21)01178-X. doi: 10.1016/j.jmig.2021.09.714. Online ahead of print.
ABSTRACT
STUDY OBJECTIVE(S): In this study, we describe trends of all three routes of hysterectomy, patient demographics, and perioperative morbidity among women undergoing surgery for benign indications between 2007-2017. We also sought to compare the rates of ELOS and readmission rates among the laparoscopic, abdominal, and transvaginal routes.
STUDY DESIGN: Retrospective cohort study STUDY SETTING: National Database study PATIENTS: American College of Surgeons- National Surgical Quality Improvement Program (ACS-NSQIP) database to identify patients who underwent an elective hysterectomy for benign indication between 2007-2017.
INTERVENTIONS: Patients were identified using Current Procedural Terminology (CPT) codes and excluded if their indication for surgery included cancer and pelvic organ prolapse diagnoses based on International Classification of Disease (ICD) codes. Collected variables of interest included age, Body Mass Index (BMI), American Society of Anesthesiologists (ASA) classification, uterine weight > 250 grams, and operative time. Our outcomes of interest included ELOS and readmission within thirty days. ELOS was defined as a hospital admission of two days or more after laparoscopic and transvaginal hysterectomy, and greater than three days for an abdominal hysterectomy. Summary statistics were used to evaluate shifts in patient characteristics and postoperative outcomes by hysterectomy route and year of surgery. Multivariable logistic regression analysis, stratified by year, comparing laparoscopic to transvaginal and abdominal hysterectomies, was performed.
MEASUREMENTS AND MAIN RESULTS: 224,357 patients that met the inclusion and exclusion criteria. Of those, 132,567 (59.1%) underwent a laparoscopic hysterectomy; 30,105 (13.4%) a vaginal hysterectomy; and 61,685 (27.5%) an abdominal hysterectomy. The rate of laparoscopic hysterectomy increased by more than 200% between 2007-2017, while the rates of transvaginal and abdominal hysterectomies steadily decreased (-58%, -42%, respectively]). The mean age, median obesity, and ASA classification increased amongst women undergoing hysterectomy across all routes with the sharpest increase within the laparoscopic hysterectomy group (% increase in mean age [2.1%, 1.3%, 0.7%] and mean BMI [9.1%, 4.3%, 3.7%] for laparoscopic, transvaginal and abdominal routes, respectively). In 2017 the odds of ELOS were 29% lower for those who received laparoscopic compared to those who received abdominal hysterectomy (P<0.001). Comparing the rates of readmission between the laparoscopic and abdominal hysterectomy groups shows that the odds of readmission is significantly lower for patients who receive a laparoscopic hysterectomy across all eleven years (P<0.001).
CONCLUSION(S): The rates of laparoscopic hysterectomy have been steadily increasing over the past eleven years. This large retrospective study confirms the lowest rates of readmission and extended length of stay within the laparoscopic hysterectomy group despite the rising medical complexity of the patients.
PMID:34610464 | DOI:10.1016/j.jmig.2021.09.714
