Elsevier

Urology

Volume 97, November 2016, Pages 66-72
Urology

Female Urology, Urodynamics, Incontinence, and Pelvic Floor Reconstructive Surgery
Occurrence of and Risk Factors for Urological Intervention During Benign Hysterectomy: Analysis of the National Surgical Quality Improvement Program Database

https://doi.org/10.1016/j.urology.2016.06.037Get rights and content

Objective

To determine the occurrence of lower genitourinary tract (LGUT) injury during hysterectomy for benign disease and identify risk factors for LGUT injury, with a specific focus on the effect of hysterectomy modality.

Methods

We performed a retrospective cohort study of patients undergoing hysterectomy for benign disease from 2010 t o 2014 using the American College of Surgeons National Surgical Quality Improvement Program, a multi-institutional prospective registry that captures perioperative surgical outcomes. We identified the occurrence of concomitant cystoscopy and therapeutic urologic interventions including endoscopic ureteric stenting, ureteric repair, bladder repair, cystectomy, and urinary diversion as a proxy for LGUT injuries. Adjusted odds ratios and 95% confidence intervals were calculated using multivariate logistic regression.

Results

We identified 101,021 patients treated with hysterectomy for benign disease: 18,610 (18.4%), 27,427 (27.2%), and 54,984 (54.4%) underwent vaginal, open, and laparoscopic hysterectomy, respectively. Cystoscopy was performed in 16,493 cases (16.3%). There were 2427 patients (2.4%) who underwent concomitant urologic intervention. Patients undergoing laparoscopic hysterectomy had increased occurrence of urologic intervention, excluding cystoscopy (adjusted odds ratio 1.47, 95% confidence interval 1.29-1.69), compared to vaginal hysterectomy; no differences were found between open and vaginal hysterectomy or laparoscopic and open hysterectomy. Larger uteri, a postoperative diagnosis of endometriosis, increasing comorbidity, and African American race were associated with an increased odd of urologic intervention whereas concomitant cystoscopy was associated with a decreased chance.

Conclusion

The incidence of lower genitourinary tract intervention in benign hysterectomy is significant and may be higher than previously reported. Predisposing patient factors and operative technique are key risk factors.

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.

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    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.

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