Uterine weight and complications after abdominal, laparoscopic, and vaginal hysterectomy

Louie, Michelle; Strassle, Paula D.; Moulder, Janelle K.; Dizon, A. Mitch; Schiff, Lauren; Carey, Erin T.

doi:10.1016/j.ajog.2018.06.015

Cited by 46 publications

(35 citation statements)

References 21 publications

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“…Patient triaging has been used to determine resource allocation in: emergency departments (Ferrand et al, 2018), surgical care delivery (Sobol & Wunsch, 2011;Weaver, Litwin, & Martin, 1993), and general health care delivery (Sun, Argon, & Ziya, 2017). In the context of the surgical procedure of hysterectomy, the relevant measure of criticality of disease condition for a patient is the uterine weight of the patient (Louie et al, 2018;Wasson, Magtibay, & Magrina, 2017). In the context of the surgical procedure of hysterectomy, the relevant measure of criticality of disease condition for a patient is the uterine weight of the patient (Louie et al, 2018;Wasson, Magtibay, & Magrina, 2017).…”

Section: Patient Triaging Based On the Criticality Of Disease Condimentioning

confidence: 99%

“…Therefore, it is conceivable that a patient triaging policy for performing robot-assisted surgery informed by the criticality of the disease condition of a patient is likely to result in improved clinical outcomes for the patient. In the context of the surgical procedure of hysterectomy, the relevant measure of criticality of disease condition for a patient is the uterine weight of the patient (Louie et al, 2018;Wasson, Magtibay, & Magrina, 2017). Uterine weight for hysterectomy patients is significantly associated with clinical outcome measures such as surgical duration, blood loss, and length-of-stay at a hospital (O'Hanlan, McCutcheon, & McCutcheon, 2011).…”

Section: Patient Triaging Based On the Criticality Of Disease Condimentioning

confidence: 99%

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Robot‐assisted surgical care delivery at a hospital: Policies for maximizing clinical outcome benefits and minimizing costs

Mukherjee

Sinha

2019

J of Ops Management

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Robot-assisted surgery is a major advancement in minimally invasive surgical care delivery. It allows surgeons to gain additional dexterity, improved precision in surgical tasks, enhanced three-dimensional vision of the surgical field, and superior accessibility to the surgical field. Notwithstanding the clinical outcome benefits (such as reduced blood loss and surgical duration, and shorter length-of-stay at a hospital), the cost of performing robot-assisted surgery is significantly high, due to the investments needed for robot acquisition, maintenance, and procurement of surgical accessories. In this study, we address the twin objectives of a hospital where robot-assisted surgery is performed: maximize the clinical outcome benefits and minimize the total cost of robot-assisted surgery. The surgical robot that is the focus of the study is a da Vinci surgical system. The surgical procedure that serves as the context of this study is hysterectomy. We demonstrate the application of an integrated methodological approach-combining empirical analysis involving an on-site, prospective investigation at a hospital and retrospective analysis of archival data from the hospital for robustness checks, analytical modeling, and discrete event simulation-to identify and analyze actionable policies that a hospital can implement. The specific policies we analyze are related to: (a) patient triaging for robot-assisted surgery based on the criticality of disease condition of a patient; (b) the optimal size of surgeon pool to facilitate the development of surgeon experience and learning; and (c) the minimum experience level of a surgeon with a robot needed to be included in the surgeon pool for robot-assisted surgery. The key contributions of this article are in demonstrating the following: First, hospital-level policies can help to realize both the clinical outcome and cost benefits of a surgical robot. Second, the criticality of patient condition is a significant determinant of surgeon learning in robot-assisted surgery. Third, application of the proposed integrated methodological approach can yield nuanced and actionable insights into an operational setting where data availability is limited and generalizability of study insights is a concern, as is the case in this study. K E Y W O R D Scost of healthcare, hospital policy, hysterectomy, multi-method study, surgeon learning, robot-assisted surgery

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Section: Patient Triaging Based On the Criticality Of Disease Condimentioning

confidence: 99%

Section: Patient Triaging Based On the Criticality Of Disease Condimentioning

confidence: 99%

Robot‐assisted surgical care delivery at a hospital: Policies for maximizing clinical outcome benefits and minimizing costs

Mukherjee

Sinha

2019

J of Ops Management

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“…6 Uterine size is one of the main factors affecting the surgeon's choice to perform VH. [7][8][9][10] Although the upper limit of uterine size for VH has not been established, a 16-week uterine size has been regarded as a reasonable upper limit by many surgeons. 11 Enlarged uterine size has been associated with greater blood loss, visceral injuries, and prolonged operative times in some studies.…”

Section: Introductionmentioning

confidence: 99%

“…11 Enlarged uterine size has been associated with greater blood loss, visceral injuries, and prolonged operative times in some studies. 7,12,13 However, VH can be performed safely by experienced surgeons even in patients with extremely enlarged uteri. [14][15][16] Uterine-size-reduction methods-such as intramyometrial coring, bivalving techniques, or vaginal myomectomy-can facilitate the surgical procedure in appropriate cases.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Uterine Weight on the Surgical Outcomes of Vaginal Hysterectomy

Güneş

Ünal

Usubütün

et al. 2019

Journal of Gynecologic Surgery

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Objective: The aim of this research was to determine the association between uterine weight and surgical outcomes of vaginal hysterectomies (VHs). Materials and Methods: This retrospective cohort study was conducted through a residency training program for performing VH operations (N = 87) in the Hacettepe University Hospital, Sıhhıye/Ankara, Turkey. VHs performed for benign gynecologic conditions were included in the study. The patients were divided into 2 groups: (1) uterine weight <100 g and (2) uterine weight ‡100 g. Clinical characteristics, demographic features, surgical characteristics, and operative complications were compared between the groups. Results: There were 57 patients (65.5%) in group 1 (uterine weight <100 g) and 30 patients (34.5%) in group 2 (uterine weight ‡100 g). Mean uterine weights were 61.56-17.98 g in group 1 and 146.30-45.16 g in group 2. There was no statistically significant difference between the groups in terms of surgical procedures performed concomitantly. A statistically significant difference was found between the groups in terms of age (59.35-9.95 for group 1 and 47.37-3.64 for group 2; p < 0.001). In group 2, the following were statistically significantly higher: mean operation time (p < 0.001); delta Hb (p < 0.001); blood loss (p < 0.001); surgical complications (p < 0.005); mean total hospital stay (p < 0.001); analgesic needs (p < 0.001); blood transfusions (p < 0.02); and readmissions to the hospital (p < 0.001). Conclusions: All patients should be evaluated and scanned prior to VH to determine uterine size and weight in order to choose the best surgical approach. (J GYNECOL SURG 35:184

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Association of maximum uterine diameter with postoperative complications in laparoscopic supracervical hysterectomy: A retrospective cohort study

Chu,

Ding

2024

Intl J Gynecology & Obste

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ObjectiveTo determine the maximum uterine diameter threshold associated with an elevated risk of complications following laparoscopic supracervical hysterectomy (LSH).MethodsThis was a retrospective cohort study from a single tertiary referral center. We enrolled patients who underwent LSH for benign indications at our hospital between January 2013 and June 2023. The primary outcome was the occurrence of surgical complications within the 30‐day timeframe of hysterectomy. The covariate included the year of the procedure, patient age, body mass index, parity, American Society of Anesthesiologists classification, comorbidities, history of previous abdominal and pelvic surgery, and preoperative anemia, blood loss, surgical time, hospital stay and pathology. The exclusion criteria comprised those who underwent hysterectomy for malignancy, individuals who underwent total vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy, and those with missing data on uterine maximum diameter, study outcomes, or covariates.ResultsWe included a final sample of 120 patients, revealing a median uterine diameter of 9.12 cm, with 9.2% experiencing complications. The median uterine weight among 40 patients was 275 g. Receiver operating characteristic (ROC) curve analysis suggested a potential cutoff of 11.55 cm for predicting complications, with an area under the ROC curve of 0.67. Multivariate logistic regression confirmed a significant association between uterine diameter exceeding the cutoff and increased complication risk (OR 33.925, 95% CI: 2.294–501.690, P = 0.0103). A correlation (r = 0.762, P < 0.001) between uterine weight and diameter indicated the latter's suitability for preoperative assessment of uterine weight.ConclusionThe maximum uterine diameter with an optimal cutoff of 11.55 cm was associated with increased complication risk.

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Uterine weight and complications after abdominal, laparoscopic, and vaginal hysterectomy

Cited by 46 publications

References 21 publications

Robot‐assisted surgical care delivery at a hospital: Policies for maximizing clinical outcome benefits and minimizing costs

Robot‐assisted surgical care delivery at a hospital: Policies for maximizing clinical outcome benefits and minimizing costs

Impact of Uterine Weight on the Surgical Outcomes of Vaginal Hysterectomy

Association of maximum uterine diameter with postoperative complications in laparoscopic supracervical hysterectomy: A retrospective cohort study

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