To describe the rate and odds of short-term postoperative complications among patients undergoing minimally invasive total (TH) compared to supracervical (SCH) hysterectomy for uterine fibroids.
Design:
Prospective cohort study.
Setting:
American College of Surgeons National Surgical Quality Improvement Program database from 2012-2020.
Patients or Participants:
Patients with a diagnosis of uterine fibroids.
Interventions:
Minimally invasive TH and SCH.
Measurements and Main Results:
We compared characteristics of women who underwent TH and SCH and identified risk factors associated with the occurrence of 30-days postoperative complications defined according to the Clavien-Dindo classification.
Multivariable regression analysis including age, BMI, race, comorbidities, ASA classification, uterine weight and concomitant procedures, was performed to identify the adjusted odds of postoperative complications. The primary outcome were the risks of any, minor and major postoperative complications according to surgical approach.
A total of 56,740 and 6,383 patients underwent minimally invasive TH and SCH respectively. Operative time was shorter (142.45 vs. 150.55 minutes, p<0.001), and the proportion of uterine weight >250 g was lower (37.6% vs. 45.1%, p<0.001) in the TH group. The rates of any (6.9% vs. 5.3%, p<0.001), minor (4.7% vs. 4.1%, p<0.037), and major (2.7% vs. 1.6%, p<0.001) complications were higher in the TH group.
In multivariable regression analysis, SCH was independently associated with lower risk of any [aOR 95% CI 0.75 (0.66-0.84)], minor [aOR 95% CI 0.86 (0.75-0.98)], and major [aOR 95% CI 0.57 (0.46-0.70)] complications compared to TH.
Conclusion:
Compared with TH, SCH is associated with a lower risk of short-term postoperative complications among patients with uterine fibroids. While previous studies reported comparable postoperative outcomes in both surgical approaches, data are limited and not focused on uterine fibroids as the surgical indication. The current study findings can aid in shared decision-making prior to MIS for uterine fibroids.