102 Is advanced preoperative imaging associated with lower perioperative adverse outcomes in women undergoing laparoscopic hysterectomy?

Abstract

Traditionally, ultrasound is the gold standard imaging study prior to pelvic surgery. It is not well characterized how advanced imaging affects rates of perioperative adverse events in women undergoing laparoscopic hysterectomy for benign indications. Our goal was to compare the rate of perioperative adverse events in women who underwent ultrasound only versus advanced imaging (ultrasound plus CT or MRI) prior to laparoscopic hysterectomy for benign indications. We conducted a retrospective cohort study of patients undergoing either total laparoscopic hysterectomy (TLH), laparoscopic assisted vaginal hysterectomy (LAVH), or robotic assisted total laparoscopic hysterectomy (RA-TLH) between January 2016 and December 2018 who have undergone ultrasound only or advanced imaging within one year prior to their procedure. Subjects were identified through the billing query of the electronic medical record based on Current Procedural Terminology codes. Patients with a diagnosis of malignancy prior to surgery or intraoperatively were excluded. After screening, demographic and perioperative data were extracted from patient records. Postoperative adverse events were categorized according to the Clavien-Dindo classification. Our primary outcome was the rate of intraoperative and postoperative adverse events with Clavien-Dindo grade II or greater. Data were analyzed using unpaired t-test and two sample test of proportions where appropriate. Query of the medical record resulted in 151patients who met inclusion criteria with 51 patients in the advanced imaging and 100 patients in ultrasound only cohorts. Patients in the advanced imaging cohort had lower Charlson Comorbidity Index scores as compared to patients without advanced imaging. These were nonassociated with decreased likelihood of adverse events. The occurrence of adverse perioperative events among ultrasound only and advanced imaging were 31.00% (n = 31) and 17.64% (n = 9), respectively. Using chi square analysis for correlation, there is no statistically significant difference in perioperative adverse events in ultrasound only and advanced imaging cohorts (P = 0.20). There was no statistically significant difference in the overall rate of perioperative adverse events Clavien-Dindo Grade II or higher. The time increases from first imaging study to day of surgery and overall operative time for the advanced imaging groupware statistically significant (P = 0.02, P = 0.17). Women undergoing advanced imaging for laparoscopic hysterectomies do not have increased rates of adverse events when compared to their ultrasound only counterparts. Ultrasound only imaging can be safely offered to patients as the only imaging modality prior to laparoscopic hysterectomy without delay in delivery of care, increased operative time, or increased rate of adverse events.