While laparoscopic hysterectomy has benefits compared to abdominal hysterectomy, the operative times are longer. Longer operative times have been associated with negative outcomes. This study’s purpose was to elucidate if there is an operative time at which 30-day outcomes for laparoscopic hysterectomy become inferior to a more expeditiously completed abdominal hysterectomy.
This was a retrospective cohort study (Canadian Task Force classification II-2) using the American College of Surgeons National Surgical Quality Improvement Program database to identify women undergoing hysterectomy for benign indications from 2010 to 2016 by current procedural terminology code. Hysterectomy cases were stratified by approach and 60-min intervals. 30-day post-operative outcomes were analyzed by operative time and approach.
109,821 hysterectomies were included in our analysis, of which 66,560 (61%) were laparoscopic, and 43,261 (39%) were abdominal. In a multivariable logistic regression analysis comparing outcomes by surgical approach and operative time, there was no time combination in which patients who had a abdominal hysterectomy had significantly lower odds of the composite complications variable. This was true even in laparoscopic hysterectomies greater than 240 min compared to abdominal hysterectomies completed between 20 and 60 min. When compared to laparoscopic hysterectomies greater than 240 min, abdominal hysterectomies between 20 and 60 min had lower odds of sepsis and abdominal hysterectomies less than 180 min had lower odds of urinary tract infection.
Given that benefits persist even in prolonged cases, a laparoscopic approach should be offered to most patients undergoing benign hysterectomy. Surgical efficiency should be prioritized for any surgical approach.
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We would like to acknowledge The George Washington University School of Medicine and Health Sciences Department of Obstetrics and Gynecology for supporting our research. Financial support from The George Washington University School of Medicine and Health Sciences, Department of Obstetrics & Gynecology was obtained for statistical analysis.
Dr. Samantha Margulies, Dr. Maria Victoria Vargas, Dr. Kathryn Denny, Andrew Sparks, Dr. Cherie Marfori, and Dr. Richard Amdur have no conflicts of interest or financial ties to disclose. Dr. Gaby Moawad is a speaker for Intuitive Surgical. The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.
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The original article was updated to correct the author listing: the last five author names were reversed.
Electronic supplementary material
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Supplementary material 1 (DOCX 17 kb) Supplemental Table 1. Adjusted odds ratio for abdominal versus equal or longer laparoscopic hysterectomy - Additional findings. Adjusted for age, BMI, HCT, race, functional status and binary marker variables for large uterine size, DM, HTN, CHF, weight loss > 10%, pre-operative open wound, sepsis, emergency surgery, tubes/ovaries removed, cervix removed, any concurrent procedure. NA: Too few events to estimate the OR
See Table 5.
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Margulies, S.L., Vargas, M.V., Denny, K. et al. Comparing benign laparoscopic and abdominal hysterectomy outcomes by time. Surg Endosc 34, 758–769 (2020). https://doi.org/10.1007/s00464-019-06825-8
- Operative time
- Surgical approach
- Minimally invasive surgery