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Occurrence of and Risk Factors for Urological Intervention During Benign Hysterectomy: Analysis of the National Surgical Quality Improvement Program Database - 28/10/16

Doi : 10.1016/j.urology.2016.06.037 
Christopher J.D. Wallis a, 1, Douglas C. Cheung a, 1, Alaina Garbens a, Jamie Kroft b, Lesley Carr a, Avery B. Nathens c, Lesley Po b, Robert K. Nam a, Grace Liu b, Lilian Gien d, Raj Satkunasivam a, *
a Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada 
b Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada 
c Division of General Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada 
d Department of Gynecologic Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada 

*Address correspondence to: Raj Satkunasivam, M.D., M.S., Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Room A3-09a, Toronto, Ontario, Canada M4N 3M5.Division of UrologyDepartment of SurgerySunnybrook Health Sciences CentreUniversity of Toronto2075 Bayview Ave, Room A3-09aTorontoOntarioM4N 3M5Canada

Abstract

Objective

To determine the occurrence of lower genitourinary tract (LGUT) injury during hysterectomy for benign disease and identify risk factors for LGUT injury, with a specific focus on the effect of hysterectomy modality.

Methods

We performed a retrospective cohort study of patients undergoing hysterectomy for benign disease from 2010 t o 2014 using the American College of Surgeons National Surgical Quality Improvement Program, a multi-institutional prospective registry that captures perioperative surgical outcomes. We identified the occurrence of concomitant cystoscopy and therapeutic urologic interventions including endoscopic ureteric stenting, ureteric repair, bladder repair, cystectomy, and urinary diversion as a proxy for LGUT injuries. Adjusted odds ratios and 95% confidence intervals were calculated using multivariate logistic regression.

Results

We identified 101,021 patients treated with hysterectomy for benign disease: 18,610 (18.4%), 27,427 (27.2%), and 54,984 (54.4%) underwent vaginal, open, and laparoscopic hysterectomy, respectively. Cystoscopy was performed in 16,493 cases (16.3%). There were 2427 patients (2.4%) who underwent concomitant urologic intervention. Patients undergoing laparoscopic hysterectomy had increased occurrence of urologic intervention, excluding cystoscopy (adjusted odds ratio 1.47, 95% confidence interval 1.29-1.69), compared to vaginal hysterectomy; no differences were found between open and vaginal hysterectomy or laparoscopic and open hysterectomy. Larger uteri, a postoperative diagnosis of endometriosis, increasing comorbidity, and African American race were associated with an increased odd of urologic intervention whereas concomitant cystoscopy was associated with a decreased chance.

Conclusion

The incidence of lower genitourinary tract intervention in benign hysterectomy is significant and may be higher than previously reported. Predisposing patient factors and operative technique are key risk factors.

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Plan


 Financial Disclosure: The authors declare that they have no relevant financial interests.
 Funding Support: RKN is supported by the Ajmera Chair of Urological Oncology. ABN is supported by the DeSouza Chair in Trauma Research. CJDW and RS had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The funding sources had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; and preparation, review, or approval of the manuscript.


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Vol 97

P. 66-72 - novembre 2016 Retour au numéro
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