Female Urology, Urodynamics, Incontinence, and Pelvic Floor Reconstructive SurgeryOccurrence of and Risk Factors for Urological Intervention During Benign Hysterectomy: Analysis of the National Surgical Quality Improvement Program Database
Section snippets
Methods
The study was conducted and reported according to the recommendations of the RECORD statement.19
Results
We identified a total of 101,021 women meeting inclusion and exclusion criteria who underwent hysterectomy for benign disease during the study interval. Of these, 18,610 (18.4%), 27,427 (27.2%), and 54,984 (54.4%) underwent vaginal, open abdominal, and laparoscopic hysterectomy, respectively. The majority of hysterectomies (61.5%) were recorded as operations on specimens less than 250 grams (Table 1), although this information could not be derived from CPT codes for patients undergoing open
Discussion
In this analysis of a large, multi-institutional, contemporary cohort of patients undergoing hysterectomy for benign disease, the incidence of lower GU tract intervention was 2.4% as measured by concomitant urological procedures (excluding cystoscopy), including a 1.1% incidence of ureteric or bladder repair. Previous studies have estimated the rate of lower GU tract injury to be 0.2%-0.5% for patients undergoing obstetrical and gynecological surgery.2, 7, 11 However, these previous reports
Conclusion
The incidence of lower GU tract intervention in benign hysterectomy is significant and higher than previously reported. Predisposing patient factors and operative technique are key risk factors for lower GU tract injury.
Acknowledgment
The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.
References (30)
- et al.
Outcomes of iatrogenic genitourinary injuries during colorectal surgery
Urology
(2015) - et al.
Iatrogenic nonendoscopic bladder injuries over 24 years: 127 cases at a single institution
Urology
(2014) - et al.
Urinary tract injuries in laparoscopic hysterectomy: a systematic review
J Minim Invasive Gynecol
(2014) - et al.
Quality improvement in surgery: the American College of Surgeons National Surgical Quality Improvement Program approach
Adv Surg
(2010) - et al.
Understanding quality issues in your surgical department: comparing the ACS NSQIP with traditional morbidity and mortality conferences in a Canadian Academic Hospital
J Surg Educ
(2015) - et al.
Use of National Surgical Quality Improvement Program data as a catalyst for quality improvement
J Am Coll Surg
(2007) - et al.
How best to measure surgical quality? Comparison of the Agency for Healthcare Research and Quality Patient Safety Indicators (AHRQ-PSI) and the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) postoperative adverse events at a single institution
Surgery
(2011) - et al.
What are the real rates of postoperative complications: elucidatinginconsistencies between administrative and clinical data sources
J Am Coll Surg
(2012) - et al.
Variation in the incidence of uterine leiomyoma among premenopausal women by age and race
Obstet Gynecol
(1997) - et al.
Frequency of lower urinary tract injury after gastrointestinal surgery in the nationwide inpatient sample database
Am Surg
(2014)
Urinary complications of gynecologic surgery: iatrogenic urinary tract system injuries in obstetrics and gynecology operations
Clin Exp Obstet Gynecol
Increasing numbers of ureteric injuries after the introduction of laparoscopic surgery
Scand J Urol Nephrol
The diagnosis and treatment of iatrogenic ureteral and bladder injury caused by traditional gynaecology and obstetrics operation
Arch Gynecol Obstet
Urological injuries during hysterectomies: a 6-year review
J Obstet Gynaecol Res
Incidence and management of gynaecological-related ureteric injuries
Aust N Z J Obstet Gynaecol
Cited by (23)
Urological complications following gynaecological surgery
2022, Obstetrics, Gynaecology and Reproductive MedicineEvaluation and Management of Common Intraoperative and Postoperative Complications in Gynecologic Endoscopy
2022, Obstetrics and Gynecology Clinics of North AmericaCitation Excerpt :Ureteral injuries are estimated to occur in 0.02% to 1.5% of laparoscopic gynecologic procedures.22,32,35–37 Because the urinary bladder sits anterior to the uterus and cervix, injuries typically occur following extensive lysis of adhesions, such as in women with multiple prior cesarean or other pelvic surgeries.38 Risk factors also include endometriosis, urinary tract anomalies, prior pelvic irradiation, uterine size over 250 g, and obesity.
Risk Factors for Urologic Injury in Women Undergoing Hysterectomy for Benign Indication
2022, Journal of Obstetrics and Gynaecology CanadaCitation Excerpt :Various associations between race and urologic injury have been demonstrated. Black women were found to be at increased risk of urologic injury compared with women of other races,5,28 potentially owing to the greater prevalence of uterine fibroids in this population.5 In a separate cohort, Black race was a protective factor against injury, whereas Asian race was associated with the highest rates of injury, likely owing to higher rates of endometriosis.11
Risk factors of lower urinary tract injury with laparoscopic sacrocolpopexy
2022, AJOG Global ReportsUrinary Tract Injury During Gynecologic Surgery: Prevention, Recognition, and Management
2021, Obstetrics and Gynecology Clinics of North AmericaCitation Excerpt :Lower urinary tract (LUT) injuries occur in gynecologic surgery because of the close proximity of the reproductive organs to the urologic organs.1–3
Questioning concomitant cystoscopy coding during hysterectomy in the National Surgical Quality Improvement Program database
2020, American Journal of Obstetrics and Gynecology
Financial Disclosure: The authors declare that they have no relevant financial interests.
Funding Support: RKN is supported by the Ajmera Chair of Urological Oncology. ABN is supported by the DeSouza Chair in Trauma Research. CJDW and RS had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The funding sources had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; and preparation, review, or approval of the manuscript.
- 1
These authors contributed equally to this manuscript.