Kristen J Pepin1, E Francis Cook2, Sarah L Cohen3. 1. Brigham and Women's Hospital, 75 Francis St Boston, MA 02115. Electronic address: kpepin@partners.org. 2. Harvard School of Public Health, 677 Huntington Ave Boston, MA 02115. 3. Brigham and Women's Hospital, 75 Francis St Boston, MA 02115.
Abstract
BACKGROUND: While laparoscopic hysterectomy is well-established as a favorable mode of hysterectomy due to decreased perioperative complications, there is still room for improvement in quality of care. Though previous studies have described laparoscopic hysterectomy risk factors, there is currently no tool for predicting risk of complication at the time of laparoscopic hysterectomy. OBJECTIVE: Create a prediction model for complications at the time of laparoscopic hysterectomy for benign conditions. STUDY DESIGN: Retrospective cohort study including patients undergoing laparoscopic hysterectomy for benign indications between 2014 and 2017 at United States hospitals contributing to American College of Surgeons- National Surgical Quality Improvement Program Database. Data about patient baseline characteristics, perioperative complications (intraoperative complications, readmission, reoperation, need for transfusion, operative time greater than 4 hour or postoperative medical complication) and uterine weight at the time of pathologic examination were collected retrospectively. Postoperative uterine weight was used as a proxy for preoperative uterine weight estimate. The sample was randomly split to create two patient populations, one for deriving the model and the other to validate the model. RESULTS: A total of 33,123 women met inclusion criteria. The rate of composite complication was 14.1%. Complication rates were similar in the derivation and validation cohorts (14.1% [2,306/14,051] vs 13.9% [2,289/14,107], p=0.7207). The logistic regression risk-prediction tool for hysterectomy complication identified seven variables predictive of complication; history of prior laparotomy (increases odds of complication by 21%), age (2% increase odds of complication per year of life), BMI (0.2% increase odds of complication per each unit increase in BMI), parity (7% increased odds of complication per delivery), race (when compared to white women, black women had a 34% increased odds and women of other races had a 18% increased odds of complication) and American Society of Anesthesiologists score (when compared to an score = 1, score = 2 had a 31% increased odds of complication, score = 3 had a 62% increased odds and score =4 had a 172% increased odds). Predicted preoperative uterine weight also had a statistically significant non-linear relationship with odds of complication. The c statistics for the derivation and validation cohorts were 0.62 and 0.62, respectively. The model is well-calibrated for women at all levels of risk. CONCLUSION: The laparoscopic hysterectomy complication predictor model is a tool for predicting complications in patients planning hysterectomy.
BACKGROUND: While laparoscopic hysterectomy is well-established as a favorable mode of hysterectomy due to decreased perioperative complications, there is still room for improvement in quality of care. Though previous studies have described laparoscopic hysterectomy risk factors, there is currently no tool for predicting risk of complication at the time of laparoscopic hysterectomy. OBJECTIVE: Create a prediction model for complications at the time of laparoscopic hysterectomy for benign conditions. STUDY DESIGN: Retrospective cohort study including patients undergoing laparoscopic hysterectomy for benign indications between 2014 and 2017 at United States hospitals contributing to American College of Surgeons- National Surgical Quality Improvement Program Database. Data about patient baseline characteristics, perioperative complications (intraoperative complications, readmission, reoperation, need for transfusion, operative time greater than 4 hour or postoperative medical complication) and uterine weight at the time of pathologic examination were collected retrospectively. Postoperative uterine weight was used as a proxy for preoperative uterine weight estimate. The sample was randomly split to create two patient populations, one for deriving the model and the other to validate the model. RESULTS: A total of 33,123 women met inclusion criteria. The rate of composite complication was 14.1%. Complication rates were similar in the derivation and validation cohorts (14.1% [2,306/14,051] vs 13.9% [2,289/14,107], p=0.7207). The logistic regression risk-prediction tool for hysterectomy complication identified seven variables predictive of complication; history of prior laparotomy (increases odds of complication by 21%), age (2% increase odds of complication per year of life), BMI (0.2% increase odds of complication per each unit increase in BMI), parity (7% increased odds of complication per delivery), race (when compared to white women, black women had a 34% increased odds and women of other races had a 18% increased odds of complication) and American Society of Anesthesiologists score (when compared to an score = 1, score = 2 had a 31% increased odds of complication, score = 3 had a 62% increased odds and score =4 had a 172% increased odds). Predicted preoperative uterine weight also had a statistically significant non-linear relationship with odds of complication. The c statistics for the derivation and validation cohorts were 0.62 and 0.62, respectively. The model is well-calibrated for women at all levels of risk. CONCLUSION: The laparoscopic hysterectomy complication predictor model is a tool for predicting complications in patients planning hysterectomy.
Authors: Lisa M Pollack; Jerry L Lowder; Matt Keller; Su-Hsin Chang; Sarah J Gehlert; Margaret A Olsen Journal: J Minim Invasive Gynecol Date: 2021-01-01 Impact factor: 4.137