8915 Outcomes and Complications for Concurrent Hernia Repair Among Women Undergoing Hysterectomy

Abstract

<h3>Study Objective</h3> Primary hernia repair adds complexity to a planned hysterectomy and may worsen operative outcomes. The aim of this study was to determine if concurrent hernia repair (hysterectomy+hernia) is associated with an increased complication rate compared to hysterectomy alone. <h3>Design</h3> Retrospective cohort study <h3>Setting</h3> Patients who underwent hysterectomy with or without hernia repair were queried using the American College of Surgeons National Surgical Quality Improvement Program participant use file (2005-2019). <h3>Patients or Participants</h3> 369,010 patients underwent hysterectomy, and 5,071 patients had hysterectomy+hernia. Propensity score matching was performed 1:1 resulting in 5,071 patients in each group. <h3>Interventions</h3> hysterectomy, hysterectomy+hernia. <h3>Measurements and Main Results</h3> Hysterectomy+hernia had a longer operating time (OT) by 46.1 minutes (95% Confidence Interval [CI] = 42.6, 49.6; <i>p</i> < 0.001) and longer length of stay (LOS) by 0.71 days (95% CI = 0.59, 0.84; <i>p</i> < 0.001). Hysterectomy+hernia was associated with 22% higher risk (95% CI = 1.11, 1.34; <i>p</i> < 0.001) of a major complication and 34% higher risk (95% CI = 1.16, 1.56; <i>p</i> < 0.001) of a minor complication. In subgroup analyses, there was no significant effect on major complications for subjects with a body mass index (BMI) <40 kg/m², age <40 or >60 years, tobacco use, diabetes, or a minimally invasive approach. Among patients with a malignant indication for hysterectomy, hysterectomy+hernia was associated with a longer OT by 32.0 minutes (95% CI = 25.2, 38.8; <i>p</i> <0.001) and 0.35 days longer LOS (95% CI = 0.04, 0.67; <i>p</i> = 0.027) but no significant difference in major and minor complications. <h3>Conclusion</h3> Hysterectomy+hernia is associated with increased OT, LOS, and risk of major and minor complications compared to hysterectomy without hernia repair. Based on subgroup analyses, concurrent hernia repair may be considered in select patients, such as those with BMI <40 kg/m² and those proceeding with a minimally invasive hysterectomy.