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Gynecology
Risk of venous thromboembolism in abdominal versus minimally invasive hysterectomy for benign conditions

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Objective

We sought to describe the incidence of venous thromboembolism (VTE) following hysterectomy for benign conditions and to estimate if VTE incidence differs for abdominal and minimally invasive hysterectomy.

Study Design

Data for patients who underwent hysterectomy for benign conditions from 2010 through 2012 were abstracted from the American College of Surgeons National Surgical Quality Improvement Program database. Cases of VTE were compared to those without VTE. Minimally invasive hysterectomy was defined as both vaginal and laparoscopic hysterectomy. Pearson χ2 test, Student t test, and binary logistic regression were used for analysis.

Results

A total of 44,167 patients underwent hysterectomy; 12,733 (28.8%) underwent open hysterectomy, 22,559 (51.1%) underwent laparoscopic hysterectomy, and 8875 (20.1%) underwent vaginal hysterectomy. The incidence of VTE for open hysterectomy was higher (0.6%, 81/12,733) than minimally invasive hysterectomy (0.2% 73/31,434, P < .001). Open surgery (P < .001), body mass index (P = .006), race (P < .001), diabetes (P = .037), preoperative functional status (P < .001), American Society of Anesthesiologists class (P < .001), total operative time (P < .001), and time from surgery to discharge (P < .001) were each associated with VTE. Age, hypertension, current smoking, pack-year history, and year operation was performed were not associated with VTE. Using binary logistic regression, open surgery (P < .001), operative time (P < .001), and length of stay (P < .001) remained associated with VTE. The odds ratio for VTE after open hysterectomy compared with minimally invasive hysterectomy was 2.45 (95% confidence interval, 1.77–3.40).

Conclusion

In this large quality database, a minimally invasive approach to hysterectomy was independently associated with a decreased incidence of VTE when compared with open hysterectomy.

Section snippets

Materials and Methods

Patients who underwent hysterectomy for benign disease from January 2010 through December 2012 and were recorded in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database were included in this study. Current Procedural Terminology (CPT) codes were used to identify patients who underwent hysterectomy and to classify patients by route of surgery (Figure). CPT codes that include hysterectomy along with other procedures, such as lymphadenectomy, which

Results

Demographic variables and known VTE risk factors are presented in Table 1 for both cases and controls. A total of 44,167 patients underwent a hysterectomy from January 2010 through December 2012. Route of surgery was open in 12,733 patients (28.8%), laparoscopic in 22,559 patients (51.1%), and vaginal in 8875 patients (20.1%). Mean age was 47.9 ± 10.7 years and mean BMI was 30.0 ± 7.9 kg/m2. Of the patients, 7% were diabetic, 26.5% were hypertensive, and 18.5% had smoked within the last year.

Comment

The current literature on VTE following gynecologic surgery for benign indications has also reported a low rate of VTE. Two prospective trials have followed up patients after gynecologic laparoscopy with venous duplex ultrasonography and found no DVTs among 338 patients.7 In a more recent study, a prospective cohort study followed up 5297 patients undergoing hysterectomy for benign indications in Finland. They found an incidence of VTE of 0.1% for patients undergoing laparoscopic or vaginal

References (16)

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The authors report no conflict of interest.

Cite this article as: Barber EL, Neubauer NL, Gossett DR. Risk of venous thromboembolism in abdominal versus minimally invasive hysterectomy for benign conditions. Am J Obstet Gynecol 2015;212:609.e1-7.

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