Division of Minimally Invasive Gynecologic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Division of Minimally Invasive Gynecologic Surgery, Leiden University Medical Center, Leiden, the Netherlands.
Acta Obstet Gynecol Scand. 2018 Mar;97(3):285-293. doi: 10.1111/aogs.13270. Epub 2017 Dec 21.
The aim of this study was to assess the 60-day readmission rates after hysterectomy according to route of surgery and analyze risk factors for postoperative readmission.
This retrospective study included all women who underwent hysterectomy due to benign conditions from 2009 to 2015 at a large academic center in Boston. Readmission rates were compared among the following four types of hysterectomies: abdominal, laparoscopic, robotic and vaginal.
There were 3981 hysterectomy cases over the study period (628 abdominal hysterectomy, 2500 laparoscopic hysterectomy, 155 robotic hysterectomy and 698 vaginal hysterectomy). Intraoperative complications occurred more frequently in women undergoing abdominal hysterectomy (4.8%), followed by robotic hysterectomy (3.9%), vaginal hysterectomy (1.9%) and laparoscopic hysterectomy (1.6%) (p < 0.0001). Readmission rates were not significantly different among the groups; women receiving abdominal hysterectomy had an overall readmission rate of 3.5%, compared with 3.2% after robotic hysterectomy, 2.9% after vaginal hysterectomy and 1.9% after laparoscopic hysterectomy (p = 0.06). When stratifying for relevant variables, women who had an laparoscopic hysterectomy had a twofold reduction of readmission compared with abdominal hysterectomy (odds ratio 0.52, 95% confidence interval 0.31-0.87; p = 0.01). There was no significant difference in readmission when robotic hysterectomy or vaginal hysterectomy were compared individually with abdominal hysterectomy. Regarding risk factors related to readmission it was observed that perioperative complications were the largest driver of readmissions (odds ratio 667, 95% confidence interval 158-99; p < 0.0001).
The laparoscopic approach to hysterectomy was associated with fewer hospital readmissions compared with the abdominal route; vaginal, robotic and abdominal approaches had a similar risk of readmission. Perioperative complications represent the main driver of readmissions. After adjusting for perioperative factors such as surgeon type and complications, no difference in readmissions between the different routes of hysterectomy were found.
本研究旨在评估因良性疾病接受子宫切除术患者术后 60 天的再入院率，并分析术后再入院的相关风险因素。
本回顾性研究纳入了 2009 年至 2015 年期间在波士顿某大型学术中心接受子宫切除术的所有良性疾病女性患者。比较了以下四种子宫切除术方式（腹式、腹腔镜式、机器人式和经阴道式）的再入院率。
研究期间共进行了 3981 例子宫切除术（628 例腹式、2500 例腹腔镜式、155 例机器人式和 698 例经阴道式）。腹式子宫切除术患者术中并发症发生率更高（4.8%），其次是机器人式（3.9%）、经阴道式（1.9%）和腹腔镜式（1.6%）（p<0.0001）。但各手术组间的再入院率并无显著差异；行腹式子宫切除术患者的总再入院率为 3.5%，而机器人式、经阴道式和腹腔镜式分别为 3.2%、2.9%和 1.9%（p=0.06）。分层分析相关变量时发现，与腹式子宫切除术相比，腹腔镜式子宫切除术的再入院风险降低了二分之一（比值比 0.52，95%置信区间 0.31-0.87；p=0.01）。而与腹式子宫切除术相比，机器人式或经阴道式子宫切除术的再入院率并无显著差异。与再入院相关的风险因素方面，观察到围手术期并发症是导致再入院的最大因素（比值比 667，95%置信区间 158-99；p<0.0001）。
与腹式途径相比，腹腔镜式子宫切除术与较低的住院再入院率相关；经阴道、机器人式和腹式途径的再入院风险相似。围手术期并发症是再入院的主要驱动因素。调整术者类型和并发症等围手术期因素后，并未发现不同子宫切除术方式间的再入院率存在差异。
