Risk Factors for Bowel Injury in Hysterectomy for Benign Indications.

Szczegóły
Abstrakt

Tytuł:: Risk Factors for Bowel Injury in Hysterectomy for Benign Indications.
Autorzy:: Zhu CR; Department of Obstetrics and Gynecology, University of Ottawa, the Ottawa Hospital, the Ottawa Hospital Research Institute, and the Departments of Surgery and Biochemistry, Microbiology, and Immunology, University of Ottawa, the Ottawa Hospital, Ottawa, and the Department of Obstetrics and Gynecology, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada.
Mallick R
Singh SS
Auer R
Solnik J
Choudhry AJ
Chen I
Źródło:: Obstetrics and gynecology [Obstet Gynecol] 2020 Oct; Vol. 136 (4), pp. 803-810.
Typ publikacji:: Journal Article; Research Support, Non-U.S. Gov't
Język:: English
Imprint Name(s):: Publication: 2004- : Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: New York.
MeSH Terms:: Hysterectomy*/adverse effects
Hysterectomy*/methods
Intraoperative Complications*/epidemiology
Intraoperative Complications*/etiology
Endometriosis/*surgery
Gastrointestinal Tract/*injuries
Genital Diseases, Female/*surgery
Hysterectomy, Vaginal/*adverse effects
Laparoscopy/*adverse effects
Laparotomy/*adverse effects
Canada/epidemiology ; Female ; Humans ; Hysterectomy, Vaginal/methods ; Hysterectomy, Vaginal/statistics & numerical data ; Incidence ; Laparoscopy/methods ; Laparoscopy/statistics & numerical data ; Laparotomy/methods ; Laparotomy/statistics & numerical data ; Middle Aged ; Outcome and Process Assessment, Health Care ; Retrospective Studies ; Risk Assessment ; Risk Factors
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Entry Date(s):: Date Created: 20200914 Date Completed: 20201130 Latest Revision: 20210126
Update Code:: 20240105
DOI:: 10.1097/AOG.0000000000004007
PMID:: 32925612
: Czasopismo naukowe

Objective: To estimate the incidence and risk factors for bowel injury in women undergoing hysterectomy for benign indications.
Methods: A retrospective cohort study was conducted among women undergoing hysterectomy for benign indications from 2012 to 2016 at institutes participating in the American College of Surgeons National Surgical Quality Improvement Program, including both inpatient and outpatient settings. Bowel injury was identified using Current Procedural Terminology codes as patients who underwent bowel repair at the time of hysterectomy or postoperatively within 30 days. Multivariate logistic regression models were used to control for patient clinical factors and perioperative factors.
Results: Bowel injury occurred in 610 of 155,557 (0.39%) included women. After bivariate analysis, factors associated with bowel injury included age, race, body mass index, American Society of Anesthesiologists classification, increased operative time, surgical approach, type of hysterectomy, lysis of adhesions, and operative indication. After adjusting for potential confounders, bowel injury was found associated with older age, surgical indication of endometriosis, and abdominal surgical approach. Compared with the surgical indication of endometriosis (n=63/10,625), the surgical indications of menstrual disorder (odds ratio [OR] 0.33, 95% CI 0.23-0.47; adjusted odds ratio [aOR] 0.33, 95% CI 0.23-0.48; n=67/34,168), uterine leiomyomas (OR 0.80, 95% CI 0.61-1.05; aOR 0.44, 95% CI 0.33-0.59; n=243/51,232), and genital prolapse (OR 0.30, 95% CI 0.20-0.45; aOR 0.41, 95% CI 0.25-0.67; n=36/20,384) were each associated with lower odds of bowel injury. Compared with the vaginal approach to hysterectomy (n=27/27,434), the abdominal approach was found to have significantly increased odds of bowel injury (OR 10.80, 95% CI 7.31-15.95; aOR 10.49 95% CI 6.42-17.12; n=401/38,106); the laparoscopic approach had smaller but significantly increased odds (OR 2.06, 95% CI 1.37-3.08; aOR 2.03 95% CI 1.24-3.34; n=182/90,017) as well.
Conclusion: Increased risk of bowel injury is associated with endometriosis and the abdominal surgical approach to hysterectomy. These findings have implications for the surgical care of women with benign uterine disease.

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