Risk of Complication at the Time of Laparoscopic Hysterectomy; A Prediction Model Built from the National Surgical Quality Improvement Program (Nsquip) Database

Study Objective Create a prediction model for complication at the time of benign laparoscopic hysterectomy. Design Retrospective cohort study. Setting United States hospitals contributing to NSQUIP. Patients or Participants Patients undergoing laparoscopic hysterectomy for benign indications between 2014 and 2017. Interventions All patients underwent a hysterectomy by a laparoscopic approach. Data about peri-operative complications (intraoperative complications, readmission, reoperation, need for transfusion, operative time greater than 4 hours, postoperative medical complication or length of stay greater than 2 days) and uterine weight at the time of pathologic examination were collected retrospectively. Postoperative uterine weight was used as a proxy for preoperative uterine weight estimate. The sample was randomly split to create two patient populations, one for deriving the model and the other to validate the model. Measurements and Main Results A total of 33,123 women met inclusion criteria. The rate of composite complication was 9.5%. Complication rates were similar in the derivation and validation cohorts (9.4% vs 9.7%, p=0.3485). The logistic regression risk-prediction tool for hysterectomy complication identified 5 variables predictive of complication; history of prior laparotomy (increases odds of complication by 30%), predicted preoperative uterine weight (each 100 gram increase in weight increases the odds of complication by 0.06%) and race (when compared to white women, black women had a 30% increased odds and women of other races had a 24% increased odds of complication). Age and body mass index also had a statistically significant quadratic relationship with odds of complication. The c statistics for the derivation and validation cohorts were 0.57 and 0.55, respectively. The model is well calibrated, especially for patients at lowest risk of hysterectomy complication ( Conclusion The laparoscopic hysterectomy complication predictor model can be transformed into a user-friendly tool for predicting complications in patients planning hysterectomy, with a strength in identifying patients at low risk of complication. This model can be applied to clinical practice.