Peri- and postoperative outcomes in patients with endometriosis undergoing hysterectomy. (May 2022)

• Record Type: Journal Article
• Authors: Brunes, Malin; Johannesson, Ulrika; Häbel, Henrike; Forsgren, Catharina; Moawad, Gaby; Ek, Marion
• Is Part Of: European journal of obstetrics, gynecology, and reproductive biology. Volume 272(2022)
• Page Start: 104
• Page End: 109
• Publication Date: 2022-05
• Subjects: a adjusted -- ASA American Society of Anesthesiologists Physical Status Classification -- ADL days to normal activity of daily life -- AH abdominal hysterectomy -- BMI body mass index -- CI confidence interval -- EBL estimated blood loss -- ICD-10 International Statistical Classification of Diseases and Related Health Problems, Tenth Revision -- KVÅ code Classification of Surgical Procedures Version 1.9 -- LOS length of stay -- MICE multiple imputation with chained equations -- NDR national drug register -- NPR national patient register -- NQR national quality register of gynecological surgery -- OR Odds ratio -- RATLH robotic-assisted hysterectomy -- SOE salpingo-oophorectomy -- TLH total laparoscopic hysterectomy; Endometriosis -- Hysterectomy -- Complication -- Robotic -- Conversion; Obstetrics -- Periodicals; Gynecology -- Periodicals; Reproductive health -- Periodicals; Gynecology -- Periodicals; Obstetrics -- Periodicals; Reproduction -- Periodicals; Obstétrique -- Périodiques; Gynécologie -- Périodiques; Reproduction -- Périodiques; Verloskunde; Gynaecologie; Voortplanting (biologie); Gynecology; Obstetrics; Reproduction; Electronic journals; Periodicals; Electronic journals; 618.05
• DOI: 10.1016/j.ejogrb.2022.02.180
• Languages: English
• ISSNs: 0301-2115

Abstract

Highlights: Nationwide register study. Hysterectomized with endometriosis – frequent complications. Robotic – less conversions. Abstract: Objectives: To assess whether hysterectomy in patients with endometriosis is associated with higher proportion of complications compared with patients without, and whether route of hysterectomy affects this outcome. Study design: This is a population-based retrospective cohort study. Data were prospectively obtained from three National Swedish Registers. Patients undergoing a benign hysterectomy between 2015 and 2017 in Sweden were included in the study and were grouped according to a histology-proven diagnosis of endometriosis. Different hysterectomy modes were compared in patients with endometriosis. Perioperative data and postoperative complications up to 1 year after surgery were collected and measured. Results: In all, 8, 747 patients underwent a benign hysterectomy, and 1, 166 patients with endometriosis was compared with 7, 581 patients without. Patients with endometriosis had higher proportion of complications (adjusted Odds ratio aOR 1.2, 95% CI 1.0–1.4), were more often converted to abdominal hysterectomy (aOR 1.7, 95% CI 1.1–2.6), had higher estimated blood loss (EBL) (200–500 ml; aOR 1.8, 95% CI 1.4–2.3, >500 ml; aOR 3.1, 95% CI 2.2–4.4) and a longer operative time (1–2 h; aOR 2.1, 95% CI 1.4–3.2, >2 h; aOR 4.3, 95% CI 2.7–6.6) than endometriosis-free patients. The conversion rate was 13.8 times higher in total laparoscopic hysterectomy (TLH) compared with robotic-assisted laparoscopic hysterectomy (RATLH) (aOR 13.8, 95% CI 3.6–52.4). Conclusion: Higher conversion rate, higher EBL and higher frequency of complications were seen in patients with endometriosis. RATLH was associated with lower conversion rate compared to TLH.