School of Medicine and Health Sciences Poster Presentations
Outcomes of Prolonged Minimally Invasive Myomectomy Compared to Open Procedures
Poster Number
292
Document Type
Poster
Publication Date
3-2016
Abstract
Background: Myomectomy is the only fertility sparing surgical approach for the management of fibroids and is increasingly being performed via minimally invasive surgery (MIS). Although MIS has proven clinical benefits over laparotomy, longer operative times in both MIS and laparotomy are associated with adverse outcomes. Little evidence exists to identify patients at risk of excessive operating time. Furthermore, no evidence exists to differentiate an operative time at which risk increases for either approach.
Methods: Using the American College of Surgeons National Surgical Quality Improvement Program, laparoscopic and abdominal myomectomies were identified from 2005 to 2013 by CPT code. Procedures were split into laparoscopic and open, and then stratified based on operative time: < 1 hour, 1 to <2 hours, 2 to <3 hours, ≥ 3 hours. Outcomes in open cases were compared to those of laparoscopic cases by time.
Results: In all, 2403 laparoscopic and 3436 open procedures were analyzed. In general, open abdominal procedures had worse 30-day outcomes than laparoscopic procedures. Longer surgeries were associated with African American race, higher BMI, lower hematocrit, HTN, age, and large or numerous fibroids. Surgery time was longer for laparoscopic procedures compared with open procedures. Wound complications, clotting, sepsis, UTI, bleeding, return to OR, hospital LOS > 3 days, and a composite complications outcome were significantly associated with surgery time. For most outcomes, there was an increased rate with increased surgery time. After adjusting for confounders, there was no difference in complications between laparoscopic procedures < 1 hour, 1 to < 2 hours, and 2 to < 3 hours long. However, laparoscopic procedures ≥ 3 hours had a higher odds of complications compared with laparoscopic procedures < 1 hour (OR 5.46 [1.31-22.75]; p=.02)). For open procedures, there was no difference in odds of complications for cases < 1 hour and those 1 to <2 hour. However, open procedures of 2 to <3 hours had a higher odds of complications when compared to those < 1 hour long (OR 3.70 [2.20-6.23]; p<.0001).
Conclusions: Surgical time was predictive of complications in both laparoscopic and open myomectomy. Laparoscopic myomectomy had a lower complication rate overall. For laparoscopic cases, there was an increase in complications at > 3 hours compared to < 1 hour and for open cases there was an increase in complications at > 2 and < 3 hours compared to < 1 hour. Careful patient counseling and preparation to increase surgical efficiency should be prioritized for either approach.
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Open Access
1
Outcomes of Prolonged Minimally Invasive Myomectomy Compared to Open Procedures
Background: Myomectomy is the only fertility sparing surgical approach for the management of fibroids and is increasingly being performed via minimally invasive surgery (MIS). Although MIS has proven clinical benefits over laparotomy, longer operative times in both MIS and laparotomy are associated with adverse outcomes. Little evidence exists to identify patients at risk of excessive operating time. Furthermore, no evidence exists to differentiate an operative time at which risk increases for either approach.
Methods: Using the American College of Surgeons National Surgical Quality Improvement Program, laparoscopic and abdominal myomectomies were identified from 2005 to 2013 by CPT code. Procedures were split into laparoscopic and open, and then stratified based on operative time: < 1 hour, 1 to <2 hours, 2 to <3 hours, ≥ 3 hours. Outcomes in open cases were compared to those of laparoscopic cases by time.
Results: In all, 2403 laparoscopic and 3436 open procedures were analyzed. In general, open abdominal procedures had worse 30-day outcomes than laparoscopic procedures. Longer surgeries were associated with African American race, higher BMI, lower hematocrit, HTN, age, and large or numerous fibroids. Surgery time was longer for laparoscopic procedures compared with open procedures. Wound complications, clotting, sepsis, UTI, bleeding, return to OR, hospital LOS > 3 days, and a composite complications outcome were significantly associated with surgery time. For most outcomes, there was an increased rate with increased surgery time. After adjusting for confounders, there was no difference in complications between laparoscopic procedures < 1 hour, 1 to < 2 hours, and 2 to < 3 hours long. However, laparoscopic procedures ≥ 3 hours had a higher odds of complications compared with laparoscopic procedures < 1 hour (OR 5.46 [1.31-22.75]; p=.02)). For open procedures, there was no difference in odds of complications for cases < 1 hour and those 1 to <2 hour. However, open procedures of 2 to <3 hours had a higher odds of complications when compared to those < 1 hour long (OR 3.70 [2.20-6.23]; p<.0001).
Conclusions: Surgical time was predictive of complications in both laparoscopic and open myomectomy. Laparoscopic myomectomy had a lower complication rate overall. For laparoscopic cases, there was an increase in complications at > 3 hours compared to < 1 hour and for open cases there was an increase in complications at > 2 and < 3 hours compared to < 1 hour. Careful patient counseling and preparation to increase surgical efficiency should be prioritized for either approach.
Comments
Presented at: GW Research Days 2016