ORLANDO (FRONTLINE MEDICAL NEWS) The complication rate is lower with laparoscopic hysterectomy than with abdominal or vaginal hysterectomy – even for uteri over 500 g, according to findings from a nationwide cohort of more than 27,000 women.

After adjusting for numerous potential confounding factors, including medical risk factors, procedure-related variables, and patient demographics, increasing uterine weight was significantly associated with increasing odds of complications – particularly after hysterectomy for uteri over 500 g, Michelle Louie, MD, reported during an oral poster session at the annual scientific meeting of the Society of Gynecologic Surgeons.

For example, compared with uteri of 25 g or less, the adjusted odds ratios for a composite outcome of any 30-day postsurgical complication were 1.02, 1.08, 1.23, 1.47, and 1.84 for uteri at 100 g, 250 g, 500 g, 750 g, and 1000 g or greater, respectively. However, for uteri over 500 g, laparoscopic hysterectomy was associated with the lowest odds of any complication when compared with abdominal and vaginal hysterectomy (adjusted OR, 1.61, 2.16, and 2.57, respectively), said Dr. Louie of the University of North Carolina at Chapel Hill.

The same was true for uteri of 250-500 g (adjusted OR, 0.99, 1.73, and 1.06, respectively), she noted, adding that “abdominal hysterectomy always has the highest rate of a complication, except at above 850 g, when a vaginal hysterectomy is associated with a greater odds of complications.”

This secondary analysis was performed using prospectively collected quality improvement data abstracted from the American College of Surgeons National Surgical Quality Improvement Program database, which includes patient information and 30-day outcomes from more than 500 U.S. hospitals. Patients included in the analysis were 27,167 women who underwent a hysterectomy for benign conditions during 2014-2015 for whom uterine size was reported. Complications assessed included infection, vascular complications, reoperation, and readmission.

“Our study suggests that uterine weight is not an appropriate indication for abdominal hysterectomy – that we can, and should, offer a laparoscopic approach even for a markedly enlarged uterus,” she said. “We believe, therefore, that patients may benefit from referral to specialty surgeons who are able to offer a laparoscopic approach, even for a very large uterus.”

In response to a question from the audience about the role of physician experience in the findings, Dr. Louie said that it was not a covariate for which information was available, thus it was not included in the analysis.

“However, I think all of us realize that surgeon volume and surgeon experience is an important factor for patient safety,” she said.

Dr. Louie has received consulting fees from Teleflex.

SOURCE: Louie M et al. SGS 2018, Oral Poster 06 .


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