Capital Women's Care (Drs. Tyan and Hawa), Leesburg, Virginia.
Capital Women's Care (Drs. Tyan and Hawa), Leesburg, Virginia.
J Minim Invasive Gynecol. 2022 Mar;29(3):365-374.e2. doi: 10.1016/j.jmig.2021.09.714. Epub 2021 Oct 2.
In this study, we describe trends of all 3 routes of hysterectomy, patient demographics, and perioperative morbidity among women undergoing surgery for benign indications between 2007 and 2017. We also sought to compare the rates of extended length of stay (ELOS) and readmission rates among the laparoscopic, abdominal, and transvaginal routes.
A retrospective cohort study.
National database study.
The American College of Surgeons National Surgical Quality Improvement Program database to identify patients who underwent an elective hysterectomy for benign indication between 2007 and 2017.
Patients were identified using Current Procedural Terminology codes and excluded if their indication for surgery included cancer and pelvic organ prolapse diagnoses based on International Classification of Diseases codes. The collected variables of interest included age, body mass index, American Society of Anesthesiologists classification, uterine weight of >250 grams, and operative time. Our outcomes of interest included ELOS and readmission within 30 days. ELOS was defined as a hospital admission of 2 days or more after laparoscopic and transvaginal hysterectomy and greater than 3 days for an abdominal hysterectomy. Summary statistics were used to evaluate shifts in patient characteristics and postoperative outcomes by hysterectomy route and year of surgery. Multivariable logistic regression analysis, stratified by year, comparing laparoscopic with transvaginal and abdominal hysterectomies was performed.
There were 224 357 patients who met the inclusion and exclusion criteria. Of those, 132 567 (59.1%) underwent a laparoscopic hysterectomy, 30 105 (13.4%) a vaginal hysterectomy, and 61 685 (27.5%) an abdominal hysterectomy. The rate of laparoscopic hysterectomy increased by >200% between 2007 and 2017, whereas the rates of transvaginal and abdominal hysterectomies steadily decreased (-58% and -42%, respectively) The mean age, median obesity, and American Society of Anesthesiologists classification increased among women undergoing hysterectomy across all routes with the sharpest increase within the laparoscopic hysterectomy group (% increase in mean age [2.1%, 1.3%, 0.7%] and mean body mass index [9.1%, 4.3%, 3.7%] for laparoscopic, transvaginal, and abdominal routes, respectively). In 2017, the odds of ELOS were 29% lower for those who received laparoscopic than those who received abdominal hysterectomy (p <.001). Comparing the rates of readmission between the laparoscopic and abdominal hysterectomy groups shows that the odds of readmission are significantly lower for patients who receive a laparoscopic hysterectomy across all 11 years (p <.001).
The rates of laparoscopic hysterectomy have been steadily increasing over the past 11 years. This large retrospective study confirms the lowest rates of readmission and ELOS within the laparoscopic hysterectomy group despite the rising medical complexity of the patients.
本研究旨在描述 2007 年至 2017 年间，因良性指征接受手术的女性中，所有 3 种子宫切除术途径、患者人口统计学特征和围手术期发病率的趋势。我们还试图比较腹腔镜、腹部和经阴道途径的延长住院时间（ELOS）和再入院率。
回顾性队列研究。
国家数据库研究。
美国外科医师学会国家手术质量改进计划数据库，以确定 2007 年至 2017 年间因良性指征接受择期子宫切除术的患者。
使用当前手术程序术语代码识别患者，并排除基于国际疾病分类代码的癌症和盆腔器官脱垂诊断的手术指征。我们感兴趣的收集变量包括年龄、体重指数、美国麻醉医师协会分类、子宫重量>250 克和手术时间。我们感兴趣的结果包括 30 天内的 ELOS 和再入院。ELOS 定义为腹腔镜和经阴道子宫切除术 2 天或以上，腹部子宫切除术 3 天或以上的住院时间。使用描述性统计数据按子宫切除术途径和手术年份评估患者特征和术后结果的变化。对每年进行分层的多变量逻辑回归分析，比较腹腔镜与经阴道和腹部子宫切除术。
共有 224357 名符合纳入和排除标准的患者。其中，132567 名（59.1%）接受了腹腔镜子宫切除术，30105 名（13.4%）接受了阴道子宫切除术，61685 名（27.5%）接受了腹部子宫切除术。2007 年至 2017 年间，腹腔镜子宫切除术的比例增加了 200%以上，而经阴道和腹部子宫切除术的比例稳步下降（分别下降 58%和 42%）。接受子宫切除术的女性的平均年龄、中位肥胖和美国麻醉医师协会分类在所有途径中均有所增加，腹腔镜子宫切除术组的增幅最大（平均年龄[2.1%、1.3%、0.7%]和平均体重指数[9.1%、4.3%、3.7%]）。2017 年，接受腹腔镜手术的患者的 ELOS 时间比接受腹部手术的患者低 29%（p<0.001）。比较腹腔镜和腹部子宫切除术组的再入院率显示，接受腹腔镜子宫切除术的患者再入院率显著降低（p<0.001）。
在过去的 11 年中，腹腔镜子宫切除术的比例稳步上升。这项大型回顾性研究证实，尽管患者的医疗复杂性不断上升，但腹腔镜子宫切除术组的再入院率和 ELOS 最低。
