Personalising the risk of conversion from laparoscopic to open hysterectomy in benign conditions: Development and external validation of risk prediction models

Madhvani, K.; Zamora, Javier; Carpenter, Tyrone; Khan, Khalid S.

doi:10.1111/1471-0528.17043

Cited by 5 publications

(7 citation statements)

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“…45,52 The HES data have been used previously to produce prediction models. 33,47 The most significant risk factor for major complications in both models was the presence of adhesions, which is consistent with existing literature. 11,20,24,26 Adhesions should be suspected if there is a previous history of laparotomy, 39 cesarean section, 53 pelvic infection or endometriosis, 2,39 and can be reliably diagnosed preoperatively using ultrasonography.…”

Section: Discussionsupporting

confidence: 89%

“…Ethnicity has been shown to be an independent factor influencing the route and complications of hysterectomy. 3 , 25 , 27 , 30 , 33 – 37 Our categorization of ethnicity is more detailed than the previous model available. 29 …”

Section: Methodsmentioning

confidence: 99%

“… 48 Hospital Episode Statistics data have been used previously to develop prediction models. 33 , 47 We used a multivariable logistic regression modelling approach with prespecified predictors and did not use a selection strategy. We assessed nonlinear association between age and major complications using fractional polynomials, quadratic terms and a step function, and we decided to model age as a quadratic term (Appendix 2, Supplementary Figure 1, available at www.cmaj.ca/lookup/doi/10.1503/cmaj.220914/tab-related-content ).…”

Section: Methodsmentioning

confidence: 99%

“…Ethnicity has been shown to be an independent factor influencing the route and complications of hysterectomy. 3,25,27,30,[33][34][35][36][37] Our categorization of ethnicity is more detailed than the previous model available. 29 We identified clinical predictors for conversion from ICD-10 codes for obesity and diabetes.…”

Section: Predictorsmentioning

confidence: 99%

“…These specific codes have not been validated, although they have been used in several previous analyses. 3,19,31,33,40,41 Previous validation studies of HES coding have shown acceptable reliability, [42][43][44] and a 2012 systematic review reported that the the accuracy of diagnostic coding using HES data was 83%-96%. 45 A full list of codes and their description that we used to formulate these predictors can be found in Appendix 1, Supplementary Table 6.…”

Section: Predictorsmentioning

confidence: 99%

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Predicting major complications in patients undergoing laparoscopic and open hysterectomy for benign indications

Madhvani

Garcia

Zamora

et al. 2022

CMAJ

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Background: Hysterectomy, the most common gynecological operation, requires surgeons to counsel women about their operative risks. We aimed to develop and validate multivariable logistic regression models to predict major complications of laparoscopic or abdominal hysterectomy for benign conditions. Methods: We obtained routinely collected health administrative data from the English National Health Service (NHS) from 2011 to 2018. We defined major complications based on core outcomes for postoperative complications including ureteric, gastrointestinal and vascular injury, and wound complications. We specified 11 predictors a priori. We used internal–external cross-validation to evaluate discrimination and calibration across 7 NHS regions in the development cohort. We validated the final models using data from an additional NHS region. Results: We found that major complications occurred in 4.4% (3037/68 599) of laparoscopic and 4.9% (6201/125 971) of abdominal hysterectomies. Our models showed consistent discrimination in the development cohort (laparoscopic, C-statistic 0.61, 95% confidence interval [CI] 0.60 to 0.62; abdominal, C-statistic 0.67, 95% CI 0.64 to 0.70) and similar or better discrimination in the validation cohort (laparoscopic, C-statistic 0.67, 95% CI 0.65 to 0.69; abdominal, C-statistic 0.67, 95% CI 0.65 to 0.69). Adhesions were most predictive of complications in both models (laparoscopic, odds ratio [OR] 1.92, 95% CI 1.73 to 2.13; abdominal, OR 2.46, 95% CI 2.27 to 2.66). Other factors predictive of complications included adenomyosis in the laparoscopic model, and Asian ethnicity and diabetes in the abdominal model. Protective factors included age and diagnoses of menstrual disorders or benign adnexal mass in both models and diagnosis of fibroids in the abdominal model. Interpretation: Personalized risk estimates from these models, which showed moderate discrimination, can inform clinical decision-making for people with benign conditions who may require hysterectomy.

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Section: Discussionsupporting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Predictorsmentioning

confidence: 99%

Section: Predictorsmentioning

confidence: 99%

See 3 more Smart Citations

Predicting major complications in patients undergoing laparoscopic and open hysterectomy for benign indications

Madhvani

Garcia

Zamora

et al. 2022

CMAJ

Self Cite

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Operative complications of open and minimally invasive adnexal surgery compared with cases with hysterectomy: A narrative review

Statham,

Suarez,

Lahey

et al. 2024

Intl J Gynecology & Obste

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The decision to add hysterectomy to planned adnexectomy is often nuanced and likely increases the complexity of the planned procedure; however, these risks are not well characterized in practice. We conducted a comprehensive search in the PubMed database for English‐language articles from 1997 to 2022, identifying studies reporting complication rates for open and minimally invasive surgery (MIS) hysterectomy and adnexal surgeries. We calculated medians and first and third quartiles for each complication and used a Mann–Whitney U test to calculate differences between complications for minimally invasive hysterectomy and adnexal case data. We identified 135 appropriate studies for inclusion. There were higher prevalences of blood loss requiring transfusion (1.70% versus 0.13%, P = 0.01) and urinary tract injury (0.80% versus 0.20%, P = 0.001) in MIS hysterectomy cases compared with MIS adnexal surgery, respectively. MIS hysterectomy cases were similar to MIS adnexal surgery cases in the risk of surgical site infection (1.20% versus 1.49%, P = 0.74), bowel injury (0.50% versus 0.35%, P = 0.45), vascular injury (0.20% versus 0.9%, P = 0.82), and conversion to laparotomy (1.95% versus 3.84%, P = 0.49). There were not enough data on open adnexal surgery complications to make a meaningful comparison between complications of open hysterectomy and adnexal‐only cases. Patients should be counseled that the addition of hysterectomy to planned MIS adnexal surgery likely increases the risk of blood loss requiring transfusion and urinary tract injury. The increased comorbidity associated with adding hysterectomy to planned open adnexal removal is less clear.

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Optimization of surgical treatment of uterine myoma in women with obesity and the metabolic syndrome

Kosei,

Tatarchuk,

Plaksiieva

et al. 2023

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Objectives: to evaluate the benefits of delayed conservative myomectomy with the aim of reducing body weight and correcting hematological and metabolic parameters against the background of the use of gonadotropin-releasing hormone (GnRH) agonists and a combination of myo-inositol and D-chiro-inositol (Inofolic combi) in obese patients with metabolic syndrome by comparing this technique with immediate surgery.Materials and methods. The study included 72 patients with uterine fibroids and obesity who required conservative myomectomy. Patients were offered to postpone surgical intervention in order to correct body weight, metabolic and hematological indicators. As a preoperative preparation, patients were recommended to use GnRH agonists (goserelin), inositols, and iron preparations for anemia. Patients were divided into 2 groups: the first group (n = 31) followed all these recommendations, the second group (n = 41) refused to follow the recommendations and postponed surgical treatment. Group 1 underwent surgical treatment 3 months after the start of treatment, group 2 – after the initial consultation.Results. Patients of the first group lost an average of 7.3 ± 1.4 kg of body weight during preoperative preparation, their hemoglobin level increased by an average of 21.78%, and the volume of the largest myomatous node decreased by an average of 21.82%. The duration of the operation was significantly shorter in group 1 (75 ± 3.84 min) than in group 2 (118 ± 5.33 min). Laparotomy in the first group was not performed in any patient, in the second group it was performed in 9 patients (21.95%) (p < 0.05). There was a decrease in the severity of postoperative pain in group 1, (3.4 В± 1.25 points on the visual analog scale), which was significantly lower than in group 2 (5.1 В± 3.4 points).Conclusions. Body weight reduction against the background of the use of GnRH agonists (goserelin) and inositols (Inofolic combi) due to the improvement of the technical conditions of the operation, metabolic and hematological indicators allow to reduce the duration of surgical intervention and the frequency of laparotomies in patients with uterine fibroids against the background of obesity and metabolic syndrome.

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Personalising the risk of conversion from laparoscopic to open hysterectomy in benign conditions: Development and external validation of risk prediction models

Abstract: Objective: To develop and validate novel prediction models to personalise the risk of conversion from laparoscopic to open hysterectomy in benign conditions.

Cited by 5 publications

References 50 publications

Predicting major complications in patients undergoing laparoscopic and open hysterectomy for benign indications

Predicting major complications in patients undergoing laparoscopic and open hysterectomy for benign indications

Operative complications of open and minimally invasive adnexal surgery compared with cases with hysterectomy: A narrative review

Optimization of surgical treatment of uterine myoma in women with obesity and the metabolic syndrome

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