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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.
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.
While surgical complexity was associated with higher admission rates, procedure lengths, and estimated blood loss, there were no significant differences between readmission or complication rates. Higher complexity was associated with increased conversion rates. This study indicates that complex cases may safely be performed laparoscopically; however, patient selection and counseling are critical in the choice of operative approach.
DISCLOSURE OF RELEVANT FINANCIAL RELATIONSHIPS: Sarah Simko: Nothing to disclose; Karin Jones: Nothing to disclose; Alireza Abidi: Nothing to disclose; Sung Park: Nothing to disclose.