Trends and Perioperative Outcomes across Elective Benign Hysterectomy Procedures from the ACS-NSQIP 2007-2017

Study Objective To delineate long-term national trends in the frequency of hysterectomy surgical routes, patient demographics, and perioperative morbidity with emphasis on extended length of stay and readmission rates. Design This retrospective cohort study evaluated 224,357 patients who underwent benign hysterectomy between 2007-2017. Setting In-patient hysterectomies performed at one of the participating hospitals in the American College of Surgeons- National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients or Participants The ASC-NSQIP database was used to recognize patients who underwent an elective benign hysterectomy between 2007-2017. Patients were identified using Current Procedural Terminology (CPT) and International Classification of Disease (ICD) codes. Interventions Laparoscopic, transvaginal, and abdominal hysterectomy for benign indications. Measurements and Main Results Summary statistics were used to evaluate shifts in patient characteristics and postoperative outcomes by hysterectomy route and year of surgery. Multivariable logistic regression analysis comparing laparoscopic to transvaginal and abdominal hysterectomies was performed, adjusting for patient characteristics and operative time. Variables of interest included age, Body Mass Index (BMI), American Society of Anesthesiologists (ASA) classification, uterine weight > 250 grams, Extended Length Of Stay (ELOS) and readmission. Our data shows that the rate of laparoscopic hysterectomy increased by more than 200% between 2007-2017 while that of transvaginal and abdominal hysterectomies decreased. Moreover, the mean age and rates of obesity amongst women undergoing hysterectomy increased steadily across all surgical routes, the sharpest increase in obesity noted amongst the laparoscopic hysterectomy group. In 2011, we noted a shift in the laparoscopic hysterectomy group, which by 2017, had 29% lower odds of ELOS as compared to the abdominal group (P Conclusion Although the benign surgical gynecology patient population is becoming increasingly complex, the risk of complications after hysterectomy is lowest when performed laparoscopically.