Louie M, et al. - Researchers investigated whether there was a connection between uterine weight and post-hysterectomy complications and whether differences in that relationship exist across vaginal, laparoscopic, and abdominal approaches. They observed that uterine weight was an independent risk factor for post-hysterectomy complications. It was noted that abdominal hysterectomy had higher odds of any complication, compared to laparoscopic hysterectomy, even for markedly enlarged uteri and uterine weight alone was not an appropriate indication for abdominal hysterectomy. They found that larger hysterectomies laparoscopically was safe to perform. Findings suggested that patients might benefit from referral to experienced surgeons who were able to offer laparoscopic hysterectomy even for markedly enlarged uteri.

Methods

• A cohort study of prospectively-collected quality improvement data was conducted from the American College of Surgeons National Surgical Quality Improvement Program database, involved patient data and 30-day postoperative outcomes from over 500 hospitals across the United States; and targeted data files, which incorporates additional data on procedure-specific risk factors and outcomes in >100 of those participating hospitals.
• Identified by Current Procedural Terminology code, patients undergoing hysterectomy for benign conditions from 2014 to 2015 were analyzed.
• Patients who had cancer, surgery by a non-gynecology specialty, or missing uterine weight were excluded.
• After that, patients were compared with respect to 30-day postoperative complications and uterine weight, stratified by surgical approach.
• Researchers used bivariable tests and multivariable logistic regression for analysis.

Results

• Twenty-seven thousand, one hundred sixty-seven patients were analyzed.
• It was observed that women with 500 g uteri were >30% more likely to have complications compared to women with uteri ≤100 g (aOR 1.34, 95% CI 1.17, 1.54, p < 0.0001), women with 750 g uteri were nearly 60% as likely (aOR 1.58, 95% CI 1.37, 1.82, p < 0.0001), and women with uteri ≥1000 g were >80% more likely (aOR 1.85, 95% CI 1.55, 2.21, p < 0.0001) after adjusting for potential confounders, including medical and surgical variables.
• It was found that the incidence of 30-day post-surgical complications was nearly double in the abdominal hysterectomy group (15%) compared to the laparoscopic group (8%).
• For each stratum of uterine weight, abdominal hysterectomy had significantly higher odds of any complication compared to laparoscopic hysterectomy, even after adjusting for potential demographic, medical, and surgical confounders.
• The study results showed that for uteri <250 g, abdominal hysterectomy had twice the odds of any complication, compared to laparoscopic hysterectomy (aOR 2.05, 95% CI 1.80, 2.33), and among women with uteri between 250–500 g, abdominal hysterectomy was correlated with an almost 80% increase in odds of any complication (aOR 1.76, 95% CI 1.41, 2.19).
• Abdominal hysterectomy was still correlated with a greater than 30% increased odds of any complication, compared to laparoscopic hysterectomy (aOR 1.35, 95% CI 1.07, 1.71) even among women with uteri >500 g.