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Comparison of laparoscopic hysterectomies for benign indication by surgical complexity to assess for differences in surgical outcomes

      Objectives

      To compare surgical outcomes following laparoscopic hysterectomies of varying complexity tier

      Materials and Methods

      A retrospective review of hysterectomies from 01/01/2019 to 07/31/2021 that took place at Kaiser Permanente Riverside and Moreno Valley was performed. Inclusion criteria included laparoscopic hysterectomies performed for benign indications in women older than 18. Malignant or urogynecology cases were excluded. Complications, urgent care, and emergency visits, and readmissions within 90 days of the surgery date were assessed. Procedure length, estimated blood loss and conversion rates were also evaluated. Kaiser’s validated three-tiered complexity scoring system (Tier 1, Tier 2, Tier 3) was used to assess complexity. Statistical analyses were completed using chi-square tests for categorical variables and analysis of variance (ANOVA) for continuous variables.

      Results

      There were a total of 1,313 hysterectomies. Twenty four cases were removed due to exclusion criteria. 1,267 were total laparoscopic hysterectomies (TLH), among which 19% were tier 1, 32% were tier 2, and 28% were tier 3 complexity. When assessing readmission rates, emergency department visits, and urgent care visits, there were no statistically significant differences by complexity tier. Among TLH, there were a total of 70 (5.5%) complications among 59 patients. The primary complications observed were wound complications (17, 1.3%), transfusions (10, 0.79%), and perforated viscus (10, 0.79%). There was a conversion rate of 1.1%. There was no difference in complication rate by tier for TLH; however, looking at converted cases, there was an increased complication rate for Tier 3 cases (p<0.01). Tier 3 cases were associated with higher rates of admission and conversion to open, as well as longer procedure lengths and increased estimated blood loss.