To determine the association between age and postoperative complications following laparoscopic hysterectomy for treatment of uterine fibroids.
Design:
A cohort study utilizing data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP).
Setting:
N/A
Patients or Participants:
Patients who underwent laparoscopic/robotic-assisted hysterectomy for fibroid uteri between 2012 and 2020.
Interventions:
Total and supracervical hysterectomy.
Measurements and Main Results:
We compared postoperative outcomes according to age groups. Multivariable regression analysis adjusting for confounders was performed. Hysterectomy for uterine fibroids was performed on 63,546 patients during the study period, of which 3% were <35 years old (n=1,842), 35% were aged 35-45 years (n=22,290), 50% were aged 45-55 years (n=31,802), and 12% were aged ≥55 years (n=7,612). A post-hoc analysis comparing age group pairs across racial groups revealed that Black individuals undergo hysterectomy at younger ages (<45) compared to older ages (p<0.05). Thirty-day postoperative complications were reported in 6.8% of cases (n=4,315) of which 4.7% were considered minor and 2.6% major, according to the Clavien-Dindo classification.
In multivariable regression analysis, compared to the <35 years old group, all other age groups had lower odds of minor complications [≥35-<45, aOR 95%CI 0.60 (0.49-0.73); ≥45-<55, aOR 95%CI 0.56 (0.46-0.68); ≥55 aOR 95%CI 0.46 (0.36-0.57)]. The ≥55 years group also had lower odds of major complications compared to the youngest group [aOR 95%CI 0.65 (0.47-0.89)].
When stratifying age according to the median (<46 vs. ≥46), older age was associated with a significant decrease in minor [aOR 95%CI 0.90 (0.83-0.97)] and major [aOR 95%CI 0.87 (0.78-0.96)] complications.
Conclusion:
Patients undergoing hysterectomy for uterine fibroid management at an older age exhibit a lower likelihood of postoperative complications compared to younger patients. The factors driving this trend necessitate further research. Potential factors may include disease severity which could prompt hysterectomy at younger ages. This observation is noteworthy given the disproportionately younger age at hysterectomy among Black individuals.
Mintz, G*1, Bar-El, L*1, Levin, G2, Truong, MD3, Wright, KN3, Siedhoff, MT3, Meyer, R3. 1OB/GYN & Women’s Health Institute, Cleveland Clinic, Cleveland, OH; 2Department of Gynecologic Oncology, Jewish General Hospital, McGill University, Quebec, Canada; 3Obstetrics & Gynecology, Cedars Sinai Medical Center, Los Angeles, CA
