30-Day Incidence of Complications and Readmission after Myomectomy

Abstract

<h3>Study Objective</h3> To determine whether open compared to minimally invasive myomectomy is associated with an increased risk of 30-day incidence of post-operative complications. <h3>Design</h3> Retrospective cohort study of prospectively collected surgical quality data. <h3>Setting</h3> American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. <h3>Patients or Participants</h3> Patients undergoing elective myomectomy for uterine leiomyomas from 2012 to 2018 were eligible. Surgery not performed by a gynecologist or with malignancy were excluded. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> A total of 20,278 patients were identified as myomectomy cases. Fifty-eight percent (n=11,742) were classified as open surgery and the remaining 42% underwent laparoscopic/robotic surgery. Patients undergoing open myomectomies were more likely to be Black/African American or Unknown Race (both p<0.01), have hypertension requiring medication (p<0.01), have clean wound status (p<0.01) and ASA classification of 3 or above (p<0.01). Average operative time was longer in laparoscopic myomectomies (164 minutes vs 121 minutes, p<0.01). Multivariable logistic regression was used to estimate the adjusted OR (aOR) and 95% confidence interval (CI) after adjusting for operative year, race, ASA classification, OR time, BMI, and age. Open myomectomies were associated with a significantly increased risk of all post-operative complications. Patients undergoing open myomectomies had 8.15 times the risk of vascular complications (aOR 8.15, 95% CI 7.01, 9.47). This large association seemed driven largely by peri-operative transfusions (aOR 8.36, 95% CI 7.18, 9.74), though risk of VTE/PE was also significantly increased (OR 2.95, 95% CI 1.49, 5.81) when investigated separately. Patients undergoing open myomectomies were also more likely to be readmitted (aOR 1.52, 95% CI 1.19, 1.94) and undergo reoperation (aOR 1.84, 95% CI 1.27, 2.67) within 30 days of surgery. <h3>Conclusion</h3> Patients undergoing open myomectomies have a higher incidence of postoperative complications despite shorter operative time. Though post-operative complications are rare, minimally invasive approaches may offer a lower risk and should be considered in appropriate surgical candidates.