The Beginning of a Paradigm Shift: Increase in Perioperative Complications Following Vaginal Hysterectomy Compared to Laparoscopic Hysterectomy Using the ACS-NSQIP 2016 - 2019 Database.

Abstract

Study objective: In this study, we compare perioperative outcomes following laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH) between 2016 and 2019.

Study design: A retrospective cohort study.

Study setting: National database study.

Patients: The American College of Surgeons National Surgical Quality Improvement Program (ACS - NSQIP) database to identify patients underwent elective LH or VH between 2016 and 2019.

Interventions: Our primary outcome of interest was a composite incidence of perioperative complications. We generated a propensity score using a multiple logistic regression model to adjust for confounding factors and to reduce the selection bias between the two groups. We matched patients who underwent elective LH to patients who underwent elective VH on the logit of the propensity score.

Measurements and main results: Of the 76,706 women in the cohort (2016-2019), 62,124 (80.9%) underwent LH and 14,582 (19.0%) underwent VH. After propensity matching (n=8,991 per group), results in the matched cohort revealed significant differences on the primary composite outcome. The composite risk of death, complications, reoperation, and readmission was lower among patients who underwent LH compared to VH, such that the primary composite outcome occurred in 5.62% of LH patients compared to 6.65% of VH patients (relative risk (RR) 0.845, 95% confidence interval (CI) 0.753 - 0.947, p = 0.004). In addition, the risk of both transfusion and readmission was higher among patients who underwent VH compared to LH (transfusion: RR 1.372, 95% CI 1.078 - 1.745, p =0.010; readmission: RR 1.546, 95% CI 1.216 - 1.966, p = 0.001).

Conclusion: We have found that there is a lower 30-day composite morbidity for patients when undergoing LH compared to VH. These data demonstrate a higher risk of perioperative complications in women undergoing VH and should further inform surgeon's surgical considerations when deciding the optimal route of hysterectomy, depending on the expertise of the surgeon.