Impact of Hysterectomy Route at the Time of SCP on Postoperative Complications

Objectives: To determine the association between postoperative complications and route of minimally invasive hysterectomy (MIH) at the time of minimally invasive sacrocolpopexy (MISCP) for treatment of pelvic organ prolapse.

Methods: Patients undergoing MISCP and concurrent MIH were identified in the National Surgical Quality Improvement Program (NSQIP) Database between the years of 2019 and 2022 using Current Procedural Terminology (CPT) Codes. Patients whose American Society of Anesthesiologists (ASA) class was not recorded and participants with missing values for age, height, weight or operative time were excluded. Descriptive statistics were used to describe the overall cohort. Minimally invasive hysterectomy included total laparoscopic hysterectomy (TLH), laparoscopic supracervical hysterectomy (SCH), laparoscopic assisted vaginal hysterectomy (LAVH) and total vaginal hysterectomy (TVH). Patient demographic and clinical factors were described. Concurrent procedures including midurethral slings and anterior or posterior compartment repairs were identified. Surgeries for oncologic indications were excluded. The primary outcome was any 30-day adverse event, which was defined as a composite outcome including any NSIQP tracked postoperative complication, readmission or reoperation. Secondary outcomes included any 30-day postoperative complication, major complications, minor complications, reoperation and readmission. Differences in patient characteristics and outcomes across MIH approach were described using chi-square and t-tests where appropriate. Univariable logistic regression analyses and multivariable logistic regression analyses were performed to determine if route of MIH was associated with adverse events controlling for the following factors: age, body mass index (BMI), current smoking status, hypertension, diabetes, concurrent midurethral sling, operative time and ASA class.

Results: During the study period, 7,690 patients were identified. The mean age was 57 years (standard deviation ±12), most patients were white (80%) with an ASA class of 2 (73%), and the mean BMI was 30 (±6) kg/m2. TLH was the most common route of MIH (56%), followed by SCH (39%), TVH (3%) and LAVH (2%). No differences in comorbid conditions were noted across hysterectomy type. Table 1 presents rates of 30-day adverse events. The rate of any 30-day adverse event was 10% and any 30-day postoperative complication was 9% with the most common complication being UTI (3%). The rate of major postoperative complications (p = 0.001) differed across hysterectomy type. On multivariable logistic regression controlling for confounders, which is presented in Table 2, SCH was associated with a 25% lower odds of any 30-day postoperative adverse event compared with TLH.

Conclusions: Adverse events following MIH at the time of SCP are associated with the route of hysterectomy, with SCH associated with the lowest rate of any 30-day adverse event compared to TLH.