Increase in Complications Following Vaginal Hysterectomy Compared to Laparoscopic Hysterectomy Using the ACS-NSQIP 2016 – 2019 Database

Abstract

<h3>Study Objective</h3> We compare postoperative outcomes following laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH) between 2016 and 2019 before and after controlling for obesity. <h3>Design</h3> A retrospective cohort study. <h3>Setting</h3> A national database study using ACS-NSQIP data from 2016 to 2019. <h3>Patients or Participants</h3> Women undergoing laparoscopic or vaginal hysterectomy between 2016 and 2019. <h3>Interventions</h3> Laparoscopic and vaginal hysterectomy. <h3>Measurements and Main Results</h3> Patient undergoing hysterectomy were identified by current procedural terminology (CPT) code. Cases with additional procedure of lymph node dissection were excluded to eliminate perioperative complications from surgeries for late-stage malignancy. Our primary outcome was a composite primary morbidity score including wound infection, sepsis, cardiovascular, thrombotic, pulmonary, and renal complications, readmission, return to the operating room, and death. Patient's undergoing LH and VH underwent propensity matching. Comparisons were made with and without matching for BMI. Multivariable logistic regression analysis was performed. After propensity matching that included BMI, we found that LH had a lower relative risk of 0.845 when compared to VH. After propensity matching that excluded BMI, we found that women with class III obesity had an increased relative risk of our composite primary morbidity of RR 1.153 (p = 0.044) and transfusion RR 1.484 (p = 0.001) when undergoing VH compared to LH. We found that these results also held true for women without class III obesity. In women with BMI <40 (non-class III obesity), there was an increased relative risk of composite primary morbidity (RR 1.178; p = 0.001), return to OR (RR 1.634; p = 0.009), and transfusion (RR 1.646; 0.004) were all significantly higher when undergoing VH compared to LH. <h3>Conclusion</h3> We found an increase in perioperative complications following VH compared to LH, regardless of BMI. To our knowledge, this is the first large database study that suggests superiority of laparoscopic approach over vaginal approach to hysterectomy. This data highlights the progress and advancements of LH.