Risk of Complication at the Time of Laparoscopic Hysterectomy: A Prediction Model Built From the National Surgical Quality Improvement Program Database

Pepin, Kristen; Cook, E.; Cohen, Sarah L.

doi:10.1097/01.ogx.0000689532.81107.0b

Cited by 5 publications

(11 citation statements)

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“…Our finding of higher risk of complications among non-White women after hysterectomy are consistent with prior studies [9][10][11][19][20][21]. Our finding of post-hysterectomy hospitalization in 3.7% of women within 30 days of hysterectomy is also consistent with previous studies [4,8].…”

Section: Discussionsupporting

confidence: 93%

Racial/Ethnic Differences in the Risk of Surgical Complications and Posthysterectomy Hospitalization among Women Undergoing Hysterectomy for Benign Conditions

Pollack¹,

Lowder²,

Keller³

et al. 2021

Journal of Minimally Invasive Gynecology

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Section: Discussionsupporting

confidence: 93%

Racial/Ethnic Differences in the Risk of Surgical Complications and Posthysterectomy Hospitalization among Women Undergoing Hysterectomy for Benign Conditions

Pollack¹,

Lowder²,

Keller³

et al. 2021

Journal of Minimally Invasive Gynecology

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“…In the current study, we aimed to design a clinically useful risk-prediction score that can be used preoperatively to estimate a patient's risk of an adverse outcome at the time of LH. A previously described risk-prediction tool has been developed using a national database [17]. The purpose of the current work was to design and validate a single-institution prediction model to account for regional differences in practices as well as to include more granular patient and surgeon information.…”

Section: Discussionmentioning

confidence: 99%

“…The sample was randomly split into 2 cohorts using a random sequence generator. One cohort was used to build the model (derivation group) and the other to test the validity of the model (validation group), as was previously described [17]. The variables entered into the model were based on previously published data and included age, race, BMI, ASA score, median income in zip code of residence, parity, history of prior laparotomy, history of prior laparoscopy, surgeon's hysterectomy volume, predicted uterine weight, and indication for surgery (pain, abnormal uterine bleeding, myomas, urogynecologic complaint, or other).…”

Section: Statisticsmentioning

confidence: 99%

“…Prior studies have characterized body mass index (BMI), age, parity, race, history of prior abdominal or pelvic surgeries, history of endometriosis, large uterine size, insurance type, operative time, fewer years of surgeon training, and low surgeon case volume as factors associated with the risk of complications at the time of LH [4,9−16]. The authors have previously reported on a risk-prediction model for LH that was built from a large national database [17]. Although generalizable to a vast population, this prediction tool was constrained by the information provided in the database and was unable to account for the surgeon's experience.…”

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confidence: 99%

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Risk-prediction Model for Patients Undergoing Laparoscopic Hysterectomy

Pepin

Cook

Maghsoudlou

et al. 2021

Journal of Minimally Invasive Gynecology

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Study Objective: Develop a model for predicting adverse outcomes at the time of laparoscopic hysterectomy (LH) for benign indications. Design: Retrospective cohort study. Setting: Large academic center. Patients: All patients undergoing LH for benign indications at our institution between 2009 and 2017. Interventions: LH (including robot-assisted and laparoscopically assisted vaginal hysterectomy) was performed per standard technique. Data about the patient, surgeon, perioperative adverse outcomes (intraoperative complications, readmission, reoperation, operative time >4 hours, and postoperative medical complications or length of stay >2 days), and uterine weight were collected retrospectively. Pathologic uterine weight was used as a surrogate for predicted preoperative uterine weight. The sample was randomly split, using a random sequence generator, into 2 cohorts, one for deriving the model and the other to validate the model. Measurements and Main Results: A total of 3441 patients were included. The rate of composite adverse outcomes was 14.1%. The final logistic regression risk-prediction model identified 6 variables predictive of an adverse outcome at the time of LH: race, history of laparotomy, history of laparoscopy, predicted preoperative uterine weight, body mass index, and surgeon annual case volume. Specifically included were race (97% increased odds of an adverse outcome for black women [95% confidence interval (CI), 34%−110%] and 34% increased odds of an adverse outcome for women of other races [95% CI, −11% to 104%] when compared with white women), history of laparotomy (69% increased odds of an adverse outcome [95% CI, 26%−128%]), history of laparoscopy (65% increased odds of an adverse outcome [95% CI, 21%−124%]), and predicted preoperative uterine weight (2.9% increased odds of an adverse outcome for each 100-g increase in predicted weight [95% CI, 2%−4%]). Body mass index and surgeon annual case volume also had a statistically significant nonlinear relationship with the risk of an adverse outcome. The c-statistic values for the derivation and validation cohorts were 0.74 and 0.72, respectively. The model is best calibrated for patients at lower risk (<20%). Conclusion:The LH risk-prediction model is a potentially powerful tool for predicting adverse outcomes in patients planning hysterectomy.

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“…However, the literature claimed that the overall complication rates for laparoscopic hysterectomy vary from 5 to 14 percent. 10,11 Data from the large systematic review reported the incidence of the urinary tract, bowel and other complications after laparoscopic hysterectomy. 12 Bowel injury incidence is quite low and found in the range of 0.34 to 0.45 percent.…”

Section: Post-operative Managementmentioning

confidence: 99%

Goel’s technique of laparoscopic hysterectomy for endometrium carcinoma

Goel

2021

Int Surg J

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The laparoscopic hysterectomy is the preferred choice in performing a hysterectomy in endometrial carcinoma. It is a great alternative to abdominal hysterectomy. The need for proper training, availability of adequate tools and infrastructure are some problems which have affected its wider reach in practice. The operating time required is more compared to abdominal hysterectomy but the merits of laparoscopic hysterectomy outweigh these problems. This technique has shown promising results due to a reduction in postoperative complications, hospital stay and a quick return to normalcy. This article described the technique of performing laparoscopic hysterectomy which the surgeon has introduced and has been practicing for the last few years. It is known as Goel’s technique after the name of the surgeon who had first described and successfully executed. This technique encompasses 10 operative steps which are fixed in a way to carry out laparoscopic hysterectomy in safe manner. It emphasizes the identification of anatomical structure before cutting down. The main attribute of this technique is that this procedure operates without the use of vaginal manipulators or Myoma screws which carries the risk of spreading malignancy in the systemic circulation. This technique has highlighted the safety factor during the operation. The technique is easy to understand for surgeons and has been well received in the patients.

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Risk of Complication at the Time of Laparoscopic Hysterectomy: A Prediction Model Built From the National Surgical Quality Improvement Program Database

Cited by 5 publications

References 0 publications

Racial/Ethnic Differences in the Risk of Surgical Complications and Posthysterectomy Hospitalization among Women Undergoing Hysterectomy for Benign Conditions

Racial/Ethnic Differences in the Risk of Surgical Complications and Posthysterectomy Hospitalization among Women Undergoing Hysterectomy for Benign Conditions

Risk-prediction Model for Patients Undergoing Laparoscopic Hysterectomy

Goel’s technique of laparoscopic hysterectomy for endometrium carcinoma

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