15: National trends in the surgical approach to an abdominal colpopexy with a concurrent hysterectomy

Abstract

To understand the national trends in laparotomy compared to laparoscopy for patients undergoing an abdominal colpopexy with a concurrent hysterectomy and to more fully characterize the 30-day complications for this subset of patients. This is a retrospective cohort study of surgical cases from The American College of Surgeons National Surgical Quality Improvement Program of female patients who underwent an abdominal colpopexy and concurrent hysterectomy from 2010 through 2017. Patients were classified as having either a laparoscopic abdominal colpopexy with a concurrent hysterectomy or an open abdominal colpopexy with concurrent hysterectomy (laparotomy). We identified 9327 surgical cases, of which 1555 (16.7%) of surgical cases were performed through a laparotomy while 7772 (85.3%) were performed laparoscopically. There were no clinically significant differences in baseline patient characteristics between those who underwent a laparotomy and those had laparoscopy. Patients were a mean of 56.6 ± 11.7 years of age at the time of surgery and had a mean BMI of 28.3 ± 5.9 kg/m 2. The proportion of patients undergoing a laparotomy decreased by 2.4% per year from 2010 through 2018 (R2=0.77) (Figure 1). Patients undergoing a laparoscopic colpopexy had from similar postoperative morbidity compared to patients undergoing a laparotomy; however, those undergoing a laparotomy were more likely to stay in the hospital 2+ days postoperatively (14.1% vs 68.0%), were more likely to need a blood transfusion (1.9% vs 0.6% p<0.01) and more likely to have a surgical site infection (2.8% vs 1.1%, p<0.01, Table 1). A laparoscopic approach is the most common for patients undergoing a colpopexy and concurrent hysterectomy. As we become increasingly adept at minimally invasive surgery, it is possible that laparotomy will become increasingly rare. We should feel reassured by the lower morbidity associated with minimally invasive surgery despite the longer operative time.View Large Image Figure ViewerDownload Hi-res image Download (PPT)