School of Medicine and Health Sciences Poster Presentations
Is There an Operative Time At Which Minimally Invasive Hysterectomy Becomes Inferior to Open Hysterectomy?
Poster Number
295
Document Type
Poster
Publication Date
3-2016
Abstract
Background
Despite the well-established benefits of minimally invasive hysterectomy, the evidence suggests longer operative times in comparison to laparotomy. Longer operative times in both minimally invasive approaches and laparotomy have been associated with adverse outcomes. Little evidence exists to guide surgeons in both identifying patients at risk of excessive operating time and determining if the at-risk patient may then benefit from an alternative surgical approach. Furthermore, no evidence exists to differentiate an operative time at which a prolonged minimally invasive hysterectomy becomes inferior to a quicker laparotomy.
Patients and Methods
Using the American College of Surgeons National Surgical Quality Improvement Program, laparoscopic and open hysterectomies were identified from 2005 to 2013 by CPT code. Procedures were split into open and laparoscopic and then stratified into operative time categories: < 1 hour, 1 to < 2 hours, 2 to < 3 hours, 3 to < 4 hours and > 4 hours. Outcomes in open cases were compared to those of laparoscopic cases by time.
Results
There were 30,160 open cases and 33,356 laparoscopic cases analyzed. Laparoscopic hysterectomies were more likely to have longer surgery times. Overall, bleeding, return to OR and wound complications were all significantly higher in open cases. Laparoscopic cases remained superior to open cases up until > 4 hours, at which time there was no difference in bleeding or wound events when compared with open cases < 2 hours, and a higher odds of return to the operating room when compared to open cases lasting 1 to < 2 hours (OR 1.66 [1.28-2.15], P=.0001). When assessing laparoscopic cases > 3 and < 4 hours, even open cases < 1 hour duration had a higher odds of the composite complication variable (OR = 2.20 [95% CI 1.89-2.56] P<.0001). A total of 11.5% of laparoscopic hysterectomy cases lasted > 4 hours.
Conclusions
Laparoscopic hysterectomy had superior outcomes than abdominal hysterectomy overall. However, a significant rise in complications was seen with at > 4 hours, at which point there was no longer a benefit to laparoscopy when compared to abdominal cases < 2 hours. Relatively few laparoscopic cases lasted > 4 hours. Careful patient counselling, preparation to increase surgical efficiency and potentially an open approach should be considered in laparoscopic hysterectomies anticipated to be > 4 hours long.
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Open Access
1
Is There an Operative Time At Which Minimally Invasive Hysterectomy Becomes Inferior to Open Hysterectomy?
Background
Despite the well-established benefits of minimally invasive hysterectomy, the evidence suggests longer operative times in comparison to laparotomy. Longer operative times in both minimally invasive approaches and laparotomy have been associated with adverse outcomes. Little evidence exists to guide surgeons in both identifying patients at risk of excessive operating time and determining if the at-risk patient may then benefit from an alternative surgical approach. Furthermore, no evidence exists to differentiate an operative time at which a prolonged minimally invasive hysterectomy becomes inferior to a quicker laparotomy.
Patients and Methods
Using the American College of Surgeons National Surgical Quality Improvement Program, laparoscopic and open hysterectomies were identified from 2005 to 2013 by CPT code. Procedures were split into open and laparoscopic and then stratified into operative time categories: < 1 hour, 1 to < 2 hours, 2 to < 3 hours, 3 to < 4 hours and > 4 hours. Outcomes in open cases were compared to those of laparoscopic cases by time.
Results
There were 30,160 open cases and 33,356 laparoscopic cases analyzed. Laparoscopic hysterectomies were more likely to have longer surgery times. Overall, bleeding, return to OR and wound complications were all significantly higher in open cases. Laparoscopic cases remained superior to open cases up until > 4 hours, at which time there was no difference in bleeding or wound events when compared with open cases < 2 hours, and a higher odds of return to the operating room when compared to open cases lasting 1 to < 2 hours (OR 1.66 [1.28-2.15], P=.0001). When assessing laparoscopic cases > 3 and < 4 hours, even open cases < 1 hour duration had a higher odds of the composite complication variable (OR = 2.20 [95% CI 1.89-2.56] P<.0001). A total of 11.5% of laparoscopic hysterectomy cases lasted > 4 hours.
Conclusions
Laparoscopic hysterectomy had superior outcomes than abdominal hysterectomy overall. However, a significant rise in complications was seen with at > 4 hours, at which point there was no longer a benefit to laparoscopy when compared to abdominal cases < 2 hours. Relatively few laparoscopic cases lasted > 4 hours. Careful patient counselling, preparation to increase surgical efficiency and potentially an open approach should be considered in laparoscopic hysterectomies anticipated to be > 4 hours long.
Comments
Presented at: GW Research Days 2016