Does Robot Assistance for Benign Hysterectomy Increase the Risk of Trendelenburg Position-Related Complications? [OP02-3B

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INTRODUCTION: Recent studies have suggested that prolonged Trendelenburg positioning during robotic-assisted total laparoscopic hysterectomy (RA-TLH) may lead to fluid shifts and resulting pulmonary, airway, head and neck, and cranial complications, however national statistics are lacking. This study examined Trendelenburg position-related complications by hysterectomy approach for benign gynecological disease. METHODS: A population-based retrospective study utilizing the National Inpatient Sample was conducted to examine total hysterectomy for benign gynecologic disease from 2008-2015. Trendelenburg position-related complications were compared between RA-TLH (n=59,061), conventional TLH (C-TLH, n=58,864), and total abdominal hysterectomy (TAH, n=791,320). Pairwise propensity score inverse probability of treatment weighting (PS-IPTW) with a generalized estimating equation was used to estimate odds ratios (OR) and 95% confidence intervals (CI). A classification tree model was used to examine factors contributing to complications. RESULTS: In the PS-IPTW model, RA-TLH was not associated with increased risk of Trendelenburg position-related complications compared to C-TLH (4.5% versus 4.5%, OR 0.99, 95% CI 0.87-1.13, P=0.871) or TAH (4.5% versus 4.7%, 0.96, 95% CI 0.87-1.06, P=0.420). Charlson Comorbidity Index (CCI) and age were most strongly associated with Trendelenburg position-related complications; women ≥80 years with a CCI of ≥4 had a disproportionally high incidence (49.1%). Moreover, Trendelenburg position-related complications were the most predictive of inpatient death following hysterectomy in the whole cohort; mortality rate was 4.9% in patients with a CCI of ≥4 at rural hospitals. CONCLUSION: RA-TLH is not associated with an increased risk of Trendelenburg position-related complications. However, older age and higher comorbidity are two key risk factors for these complications and confer high mortality risk.