National Analysis of Perioperative Morbidity of Vaginal Versus Laparoscopic Hysterectomy at The Time of Uterosacral Ligament Suspension

Abstract

Study Objective The objective of this study was to compare the morbidity of vaginal versus laparoscopic hysterectomy when performed with uterosacral ligament suspension (USLS). Design Retrospective cohort study. Setting American College of Surgeons National Surgical Quality Improvement Program database. Patients or Participants We included all patients who underwent USLS and concurrent vaginal or laparoscopic hysterectomy from 2010 to 2017. We excluded those who underwent laparoscopic-assisted vaginal hysterectomy, abdominal hysterectomy, other surgical procedures for apical pelvic organ prolapse, or had gynecologic malignancy. Interventions We compared 30-day complication rates in patients who underwent vaginal versus laparoscopic hysterectomy at the time of USLS. Measurements and Main Results We compared groups using chi-squared analysis and students t-test for categorical and continuous variables, respectively. Stepwise backward multivariate logistic regression was used to identify independent predictors of experiencing complications. The cohort was comprised of 3,349 patients who underwent vaginal hysterectomy with USLS and 484 who underwent laparoscopic hysterectomy with USLS. Patients who underwent the vaginal approach were older (58.3 vs 50.9 years), more likely to have hypertension, and to undergo concurrent minor urogynecologic procedures such as midurethral sling or colporrhaphy. Patients in the laparoscopic group had higher BMI and were more likely to smoke. Groups were otherwise similar. Patients who underwent the vaginal approach had a significantly higher rate of complications than the laparoscopic group for all complications (11.4% vs 6.4%, OR 1.9, 1.3-2.8, p=0.0005) as well as serious complications-only (5.6% vs 3.1%, OR 1.8, 1.1-3.1, p=0.02). After controlling for confounding variables on multivariate logistic regression, vaginal hysterectomy at the time of USLS remained a significant predictor of all complications (OR 2.0, 1.4-2.9, p=0.001), as well as serious complications (OR 2.1, 1.2-3.7, p=0.009). Conclusion In this large national cohort, after adjusting for known medical and surgical risk factors, vaginal hysterectomy at the time of USLS was associated with a higher complication rate than the laparoscopic route of surgery. The objective of this study was to compare the morbidity of vaginal versus laparoscopic hysterectomy when performed with uterosacral ligament suspension (USLS). Retrospective cohort study. American College of Surgeons National Surgical Quality Improvement Program database. We included all patients who underwent USLS and concurrent vaginal or laparoscopic hysterectomy from 2010 to 2017. We excluded those who underwent laparoscopic-assisted vaginal hysterectomy, abdominal hysterectomy, other surgical procedures for apical pelvic organ prolapse, or had gynecologic malignancy. We compared 30-day complication rates in patients who underwent vaginal versus laparoscopic hysterectomy at the time of USLS. We compared groups using chi-squared analysis and students t-test for categorical and continuous variables, respectively. Stepwise backward multivariate logistic regression was used to identify independent predictors of experiencing complications. The cohort was comprised of 3,349 patients who underwent vaginal hysterectomy with USLS and 484 who underwent laparoscopic hysterectomy with USLS. Patients who underwent the vaginal approach were older (58.3 vs 50.9 years), more likely to have hypertension, and to undergo concurrent minor urogynecologic procedures such as midurethral sling or colporrhaphy. Patients in the laparoscopic group had higher BMI and were more likely to smoke. Groups were otherwise similar. Patients who underwent the vaginal approach had a significantly higher rate of complications than the laparoscopic group for all complications (11.4% vs 6.4%, OR 1.9, 1.3-2.8, p=0.0005) as well as serious complications-only (5.6% vs 3.1%, OR 1.8, 1.1-3.1, p=0.02). After controlling for confounding variables on multivariate logistic regression, vaginal hysterectomy at the time of USLS remained a significant predictor of all complications (OR 2.0, 1.4-2.9, p=0.001), as well as serious complications (OR 2.1, 1.2-3.7, p=0.009). In this large national cohort, after adjusting for known medical and surgical risk factors, vaginal hysterectomy at the time of USLS was associated with a higher complication rate than the laparoscopic route of surgery.