Complication Differences Across Elective, Minimally Invasive, Outpatient Hysterectomy and Myomectomy.

OBJECTIVES

To examine differences in 30-day complications between minimally invasive myomectomy and minimally invasive hysterectomy in the outpatient setting.

METHODS

This was a retrospective, propensity-matched cohort study using data collected from the American College of Surgeons National Surgical Quality Improvement Program Participant Use Data Files from 2016 to 2021. The American College of Surgeons National Surgical Quality Improvement Program database collects surgical outcome data from over 700 hospitals in the United States. Cases selected for this study were performed in the outpatient setting. Patients aged 18-50 years who had undergone a minimally invasive elective outpatient hysterectomy or myomectomy for a primary indication of uterine fibroids. Patients were stratified by whether they underwent a minimally invasive hysterectomy or minimally invasive myomectomy. The primary outcome was the incidence of 30-day complications, with secondary outcomes including readmissions and reoperation.

RESULTS

Among 31 203 patients (median age: 43 years), 14% underwent myomectomy. Based on a matched analysis of 3413 myomectomy-hysterectomy pairs, patients who underwent myomectomy had lower odds of 30-day postoperative complication (OR 0.73; 95% CI 0.59-0.90, P = 0.003), hospital readmission (OR 0.39; 95% CI 0.27-0.57, P < 0.001), and reoperation (OR 0.33; 95% CI 0.17-0.64, P = 0.001).

CONCLUSIONS

Complication rates across these 2 surgical management options for leiomyomas favour minimally invasive myomectomy for elective outpatient cases.