PD40-12 IATROGENIC URETERAL INJURY FROM HYSTERECTOMY IN THE ERA OF MINIMALLY INVASIVE SURGERY: A NATIONAL ANALYSIS OF TRENDS, RISK FACTORS, AND OUTCOMES

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion III1 Apr 2016PD40-12 IATROGENIC URETERAL INJURY FROM HYSTERECTOMY IN THE ERA OF MINIMALLY INVASIVE SURGERY: A NATIONAL ANALYSIS OF TRENDS, RISK FACTORS, AND OUTCOMES Vignesh T. Packiam, Joseph J. Pariser, Andrew J. Cohen, Charles U. Nottingham, Sarah F. Faris, and Gregory T. Bales Vignesh T. PackiamVignesh T. Packiam More articles by this author , Joseph J. PariserJoseph J. Pariser More articles by this author , Andrew J. CohenAndrew J. Cohen More articles by this author , Charles U. NottinghamCharles U. Nottingham More articles by this author , Sarah F. FarisSarah F. Faris More articles by this author , and Gregory T. BalesGregory T. Bales More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1544AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Iatrogenic ureteral injury (UI) is a known complication of hysterectomy. Minimally invasive (MI) approaches for abdominal hysterectomy have had an unclear impact on the risk of UI. We examined trends, risk factors and outcomes of iatrogenic UI during abdominal hysterectomy with regard to MI approaches. We also assessed clinical outcomes based on approach of repair. METHODS We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005 to 2013 to identify abdominal (open (OH) or minimally invasive (MIH)) and vaginal hysterectomies (VH). UI was identified based on intra-op surgical repair or delayed repair/stent placement. Univariate analysis and multivariate logistic regression were used to identify risk factors for UI during abdominal hysterectomy. For patients who had UI during MIH, we compared MI vs open repair in terms of 30-day outcomes. RESULTS There were 310 cases of UI in 100,143 hysterectomies (0.31%). The rate of UI was 0.21% for OH, 0.45% for MIH and 0.08% for VH (p<0.01). The most common intra-op surgical repairs for UI were MI ureterorrhaphy (64%), open ureteral reimplant (17%) and MI ureteral reimplant (10%). Interestingly, increasing BMI was protective for UI (p<0.01). Although the presence of any trainee was not a risk factor for UI (p=0.92), senior resident involvement (PGY-3 or greater) was associated with UI (P<0.01). On multivariate analysis, MIH (OR 3.97 [1.99-7.91], p<0.01) and senior resident involvement (OR 3.68 [2.11-6.42], p<0.01) were independently associated with UI. For patients who had an intra-op surgical UI repair during MIH (n=206), 90% of patients underwent MI repair while 10% patients underwent converted to open repair. There was no significant difference in age, BMI, ASA class, or resident involvement between patients with MI vs open repair (all p>0.05). Patients undergoing MI vs open repair had a shorter OR time (mean 178 ± 77 vs 376 ± 121 minutes, p<0.01) and shorter length of stay (median 1 IQR (1-1) vs 3 (3-4) days, p<0.01) but similar overall complications (19% vs 11%, p=0.31) and readmissions (5% vs 5%, p=0.98). CONCLUSIONS To our knowledge, this is the largest national series assessing iatrogenic ureteral injury during hysterectomy. Minimally invasive hysterectomy is a risk factor for ureteral injury. For patients undergoing minimally invasive hysterectomy with ureteral injury, a concurrent minimally invasive repair resulted in shorter length of stay but otherwise similar 30-day outcomes. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e939 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Vignesh T. Packiam More articles by this author Joseph J. Pariser More articles by this author Andrew J. Cohen More articles by this author Charles U. Nottingham More articles by this author Sarah F. Faris More articles by this author Gregory T. Bales More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...