Postoperative Morbidity of Minimally Invasive Hysterectomy Approach and Uterine Size

Abstract

Background: The optimal approach to minimally invasive hysterectomy when uterine size is larger than 250 g is unclear. The aim of this study was to evaluate 30-day postoperative complications after minimally invasive hysterectomy by surgical approach and uterine size. Methods: The American College of Surgeons National Surgical Quality Improvement Program database was searched for patients who underwent laparoscopic or vaginal hysterectomy between 2005 and 2012. Patient demographics and 30-day postsurgical complication rates were compared by hysterectomy approach and uterine size classified as either less than or equal to 250 g (small uterine size) and greater than 250 g (large uterine size) by billing codes. Multivariable regression analyses were used to study the independent effect of uterine size on outcomes. Results: Of patients undergoing hysterectomy, 31,754 (86.2%) patients had small uterine size and 5,067 (13.8%) patients had large uterine size. No surgical approach was associated with better or worse outcomes in the large uterus size group (adjusted odds ratio (aOR): 1.00, 95% CI: 0.76 - 1.30, P = 0.990). Overall morbidity was significantly more common with large uterine size than small uterine size (5.78% and 3.44%, respectively, P < 0.001). Blood transfusions were significantly more common with large than small uterine size (3.04% and 1.11%, respectively, P < 0.001). Median operative time is increased in the large uterus size group 148 minutes compared to 111 minutes in the small uterine size group (P < 0.001). Multivariable logistic regression analyses showed that uterine size was a significant predictor of overall postoperative morbidity (aOR: 1.73, 95% CI: 1.31 - 2.29). Conclusions: No approach to hysterectomy of large uteri is clearly superior in this study. Patient and surgeon preference may guide surgical approach to minimally invasive hysterectomy with large uterine size. J Clin Gynecol Obstet. 2015;4(1):153-159 doi: http://dx.doi.org/10.14740/jcgo323w