Outcomes and Postoperative Complications After Hysterectomies Performed for Benign Compared With Malignant Indications

Abstract

Hysterectomies performed for gynecologic malignancies are associated with a more than twofold higher complication rate compared with those performed for benign conditions. Minimally invasive surgery is associated with a decreased complication rate compared with open surgery. These data can be used for patient counseling and surgical planning, determining physician and hospital costs of care, and considered when assigning value-based reimbursement.

Economic burden of cancer among patients with surgical resections of the lung, rectum, liver and uterus: results from a US hospital database claims analysis

“…More recent estimates or data specific to LAR of the rectum are not available in the literature. In regard to hysterectomy, our results are similar to those of Wallace et al, who found that of 59 525 women who underwent hysterectomies, complications and ORTs were more prevalent among those with gynecologic malignancies in comparison to women with benign conditions [8]. Furthermore, there is evidence that women with gynecologic cancers more frequently undergo bilateral salpingoophorectomy than women with benign disease [12].…”

“…Specifically among patients who underwent colon, rectal, and pancreatic resections for cancer, greater surgical complexity has been associated with worse outcomes in the 30 days following procedures [3]. Also, a study of 59,525 women who underwent hysterectomies reported a significantly longer operating time and a two-fold higher complication rate among women with gynecologic malignancies compared to women with benign conditions [8]. Better understanding of the current hospital and economic burden of technically challenging surgical resections may assist with assessing the value of new technologies that may reduce healthcare resource utilization and costs.…”

Laparoscopic hysterectomy with morcellation vs abdominal hysterectomy for presumed fibroids: an updated decision analysis following the 2014 Food and Drug Administration safety communications

“…That there was not a major swing in the conclusion of the model with integration of the expanded and improved data adds credibility to our original model. Mortality from the procedure itself (LH vs AH) was one of the most challenging clinical outcomes to assess in our original decision analysis, but we identified a newly published study 22 that provided very similar numbers to the original inputs, 23–25 again suggesting our model is robust.…”

“…In sensitivity analyses, the number of incremental deaths ranged from 20 fewer in the LH group 21 to 21 fewer in the AH group, 14 with most scenarios favoring LH (Figure 1). We also identified 1 additional study published since our original decision analysis that provided new estimates of mortality from the procedure itself, 22 0.00013 among 23,956 LH and 0.00034 among 14,616 AH. One-way sensitivity analyses using these estimates favor LH over AH in most scenarios (Figure 1).…”

Venous Thromboembolic Complications to Hysterectomy for Benign Disease: A Nationwide Cohort Study

“…One of the most common gynecologic procedures is hysterectomy, with 400 to 600 000 procedures performed per year in the United States [3,4]. Few studies have focused on the incidence of VTE in women undergoing hysterectomy for benign conditions.…”