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Tytuł pozycji:

Trends in operative time and outcomes in minimally invasive hysterectomy from 2008 to 2018.

Tytuł :
Trends in operative time and outcomes in minimally invasive hysterectomy from 2008 to 2018.
Autorzy :
Luchristt D; Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL. Electronic address: .
Brown O; Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Kenton K; Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Bretschneider CE; Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL.
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Źródło :
American journal of obstetrics and gynecology [Am J Obstet Gynecol] 2021 Feb; Vol. 224 (2), pp. 202.e1-202.e12. Date of Electronic Publication: 2020 Aug 11.
Typ publikacji :
Journal Article
Język :
English
Imprint Name(s) :
Publication: <2005->: New York : Elsevier
Original Publication: St. Louis.
MeSH Terms :
Operative Time*
Hysterectomy/*methods
Hysterectomy, Vaginal/*trends
Laparoscopy/*trends
Postoperative Complications/*epidemiology
Adult ; Female ; Humans ; Least-Squares Analysis ; Logistic Models ; Middle Aged ; Multivariate Analysis ; Odds Ratio
Contributed Indexing :
Keywords: National Surgical Quality Improvement Program*; health services outcomes*; laparoscopic hysterectomy*; major complications*; minimally invasive hysterectomy*; minor complications*; operative time*; perioperative complications*; surgical outcomes*; vaginal hysterectomy*
Entry Date(s) :
Date Created: 20200814 Date Completed: 20210216 Latest Revision: 20210216
Update Code :
20210218
DOI :
10.1016/j.ajog.2020.08.014
PMID :
32791126
Czasopismo naukowe
Background: There is a national shift toward laparoscopic hysterectomy as the predominant form of minimally invasive hysterectomy. Previous research suggests that vaginal hysterectomy is associated with lower operative time and improved outcomes; however, this has not been validated in a modern cohort of women.
Objective: This analysis aims to evaluate whether total vaginal hysterectomy remains associated with lower operative times and fewer postoperative complications than total laparoscopic hysterectomy or laparoscopic-assisted vaginal hysterectomy, given recent shifts in clinical practice patterns and training experience.
Study Design: A secondary analysis of the National Surgical Quality Improvement Program database was performed. Three primary outcomes were defined for the analysis: operative time, rate of major complications, and rate of minor complications. Secondary outcomes included changes in route of surgery over time. Descriptive analyses were performed for all outcomes of interest. Operative time, rate of major complications, and rate of minor complications were compared for each of the 3 forms of minimally invasive hysterectomy: total laparoscopic hysterectomy, laparoscopic-assisted vaginal hysterectomy, and total vaginal hysterectomy. Bivariate analyses were performed using analysis of variance, Kruskal-Wallis, Pearson chi-square, or Fisher exact tests where appropriate. Multivariable ordinary least squares and logistic regression were used to assess for overall differences in outcomes and trends over time, controlling for sociodemographic factors and medical comorbidities. Sensitivity analyses were performed using a propensity score-matched cohort created to balance groups across time.
Results: A total of 161,626 women met criteria for inclusion. Rates of total vaginal hysterectomy dropped from 51% to 13% between 2008 and 2018, whereas rates of total laparoscopic hysterectomy increased from 12% to 68% (P<.001). In multivariable analyses, total laparoscopic hysterectomy and laparoscopic-assisted vaginal hysterectomy were associated with lower odds of major complications (adjusted odds ratio [95% confidence interval]: 0.813 [0.750-0.881] and 0.873 [0.797-0.957], respectively) and minor complications (adjusted odds ratio [95% confidence interval]: 0.723 [0.676-0.772] and 0.896 [0.832-0.964], respectively) than total vaginal hysterectomy. Temporal trends show an increase in total vaginal hysterectomy operative time and decreases in total laparoscopic hysterectomy and laparoscopic-assisted vaginal hysterectomy operative times over the 11-year analysis period (P<.001), although total vaginal hysterectomy continues to have the shortest median operative time overall. No temporal trends were observed in rates of complications.
Conclusion: This analysis highlights recent shifts in rates of minimally invasive hysterectomy. Alongside this change in practice pattern, this study also brings to light a resultant shift in the complication rates associated with each surgical approach, as laparoscopic hysterectomy has lower rates of complications than vaginal hysterectomy despite longer operative times.
(Copyright © 2020 Elsevier Inc. All rights reserved.)

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