Department of Obstetrics and Gynecology, Division of Minimally Invasive GYN Surgery, Milton S Hershey Medical Center, Penn State University, Hershey, Pennsylvania.
Department of Surgery, Milton S Hershey Medical Center, Penn State University, Hershey, Pennsylvania.
Womens Health Issues. 2018 Sep-Oct;28(5):456-461. doi: 10.1016/j.whi.2018.03.006. Epub 2018 Sep 1.
We sought to determine if there is an association between preoperative risk factors as defined by the American Society of Anesthesiologists (ASA) physical status score and the route of hysterectomy for benign indications.
In this retrospective cohort study, the American College of Surgeons National Surgical Quality Improvement Project database was used to determine the route of hysterectomy, using Current Procedural Terminology codes, and associated ASA class. The analysis included abdominal, vaginal, total laparoscopic, and laparoscopic assisted vaginal routes of hysterectomy. Routes of hysterectomy were also grouped as either abdominal or minimally invasive for analysis. Multinomial logistic regression was used to model route of hysterectomy as a function of patient covariates, including ASA class, age, race and ethnicity, and body mass index.
The analysis included 117,919 patients from the National Surgical Quality Improvement Project database. Patients with ASA classification of III or IV to V had significantly decreased odds of undergoing a minimally invasive approach for hysterectomy (odds ratio [OR], 0.81 [95% confidence interval (CI)], 0.77-0.85; and OR, 0.42 [95% CI, 0.37-0.48], respectively). Secondary outcome analysis revealed that a body mass index of more than 30 kg/m was associated with significantly lower odds of undergoing a minimally invasive hysterectomy (OR, 0.87; 95% CI, 0.85-0.89). With respect to race/ethnicity, all non-White groups had decreased odds of undergoing a hysterectomy via a minimally invasive approach. Age 75 years or older was correlated with an increased likelihood of minimally invasive hysterectomy (OR, 1.18; 95% CI, 1.10-1.26).
Patients with increased preoperative risk as defined by a high ASA classification are less likely to undergo a hysterectomy using a minimally invasive route for benign indications.
我们旨在确定美国麻醉医师协会（ASA）身体状况评分定义的术前危险因素与良性指征下子宫切除术的途径之间是否存在关联。
在这项回顾性队列研究中，我们使用美国外科医师学会国家手术质量改进计划数据库来确定子宫切除术的途径，使用当前操作术语代码和相关的 ASA 分级。该分析包括腹部、阴道、全腹腔镜和腹腔镜辅助阴道子宫切除术途径。子宫切除术途径也被分为腹部或微创途径进行分析。多变量逻辑回归用于将子宫切除术途径建模为患者协变量的函数，包括 ASA 分级、年龄、种族和民族以及体重指数。
该分析包括来自国家手术质量改进计划数据库的 117919 名患者。ASA 分级为 III 或 IV 至 V 的患者接受微创子宫切除术的可能性明显降低（优势比 [OR]，0.81 [95%置信区间 (CI) ]，0.77-0.85；OR，0.42 [95% CI ，0.37-0.48]）。次要结果分析显示，体重指数超过 30 kg/m 与接受微创子宫切除术的可能性显著降低相关（OR，0.87；95% CI，0.85-0.89）。就种族/民族而言，所有非白人种族组接受微创途径子宫切除术的可能性均降低。75 岁或以上的年龄与微创子宫切除术的可能性增加相关（OR，1.18；95% CI，1.10-1.26）。
术前风险较高（定义为 ASA 分级较高）的患者不太可能因良性指征而行微创途径的子宫切除术。
