scholarly journals Association between Obesity, Surgical Route, and Perioperative Outcomes in Patients with Uterine Cancer

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Entidhar Al Sawah ◽  
Jason L. Salemi ◽  
Mitchel Hoffman ◽  
Anthony N. Imudia ◽  
Emad Mikhail
Keyword(s):  
Vaginal Hysterectomy ◽  
Uterine Cancer ◽  
Temporal Trends ◽  
Laparoscopic Hysterectomy ◽  
Total Abdominal Hysterectomy ◽  
Perioperative Outcomes ◽  
Morbidly Obese ◽  
Improvement Program ◽  
Perioperative Morbidity ◽  
Laparoscopic Assisted Vaginal Hysterectomy

Objective. To study temporal trends of hysterectomy routes performed for uterine cancer and their associations with body mass index (BMI) and perioperative morbidity. Methods. A retrospective review of the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) 2005-2013 databases was conducted. All patients who were 18 years old and older with a diagnosis of uterine cancer and underwent hysterectomy were identified using ICD-9-CM and CPT codes. Surgical route was classified into four groups: total abdominal hysterectomy (TAH), total vaginal hysterectomy (TVH), laparoscopic assisted vaginal hysterectomy (LAVH), and total laparoscopic hysterectomy (TLH) including both conventional and robotically assisted. Patients were then stratified according to BMI. Results. 7199 records were included in the study. TLH was the most commonly performed route of hysterectomy regardless of BMI, with proportions of 50.9%, 48.9%, 50.4%, and 51.2% in ideal, overweight, obese, and morbidly obese patients, respectively. The median operative time for TAH was 2.2 hours compared to 2.7 hours for TLH (p < 0.01). The median length of stay for TAH was 3 days compared to 1 day for TLH (p < 0.01). The percentage of patients with an adverse outcome (composite indicator including transfusion, deep venous thrombosis, and infection) was 17.1 versus 3.7 for TAH and TLH, respectively (p < 0.01). Conclusion. During the last decade, TLH has been increasingly performed in women with uterine cancer. The increased adoption of TLH was seen in all BMI subgroups.

Performing combined breast and gynecologic surgery does not increase the rate of surgical site infections: A NSQIP database analysis.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18093-e18093
Author(s):  
Paul Mayor ◽  
John Etter ◽  
James Brian Szender ◽  
Emese Zsiros ◽  
Peter Jonathan Frederick ◽  
...  
Keyword(s):  
Breast Surgery ◽  
Surgical Site Infections ◽  
Laparoscopic Hysterectomy ◽  
Gynecologic Surgery ◽  
Surgical Approaches ◽  
Improvement Program ◽  
Surgical Quality ◽  
Laparoscopic Assisted Vaginal Hysterectomy ◽  
Significant Difference ◽  
Laparoscopic Assisted

e18093 Background: The purpose of this study is to determine and compare the overall rates of surgical site infections (SSI) in patients undergoing breast surgery, hysterectomy and combined breast surgery and hysterectomy. Methods: We inspected the National Surgical Quality Improvement Program (NSQIP) Participant Use Files from 2005-2014 for subjects undergoing breast surgery (CPT codes 19300-19307, 19340, 19342, 19350, 19357, 19361, 19364, 19366-19369, 19380, 19396), Gynecologic surgery ( CPT Codes 58150, 58152, 58180, 58200, 58210, 58240, 58260, 58262, 58263, 58267, 58270, 58275, 58280, 58285, 58290-58294, 58541-58544, 58548, 58550, 58552-58554, 58570-58573), or a combined surgery (the NSQIP databased was queried for encounters that contained both a breast surgery code and hysterectomy procedure code). We then queried the database for SSI rates within 30 days of surgery. SSI rates were compared using a χ2 test with a nominal value of p < 0.05 as a test for significance. Results: We identified a total of 174,605 patients who underwent a breast surgery and found a SSI rate of 2.59%. We identified a total of 137,121 patients who underwent hysterectomy and found a SSI rate of 2.58%. We identified 383 patients who underwent a combined breast surgery and hysterectomy and found a SSI rate of 2.87%. When comparing SSI rates of combined breast surgery and hysterectomy, to breast surgery or hysterectomy alone, we found no significant difference in the rates of SSI between these groups (p = .7304). We analyzed SSI rates in patients by different surgical approaches including combined breast surgery and open hysterectomy and found an SSI rate of 4.35% (p = .357), combined breast surgery and laparoscopic hysterectomy and found an SSI rate of 2.38% (p = .931), and combined breast surgery and laparoscopic assisted vaginal hysterectomy and found an SSI rate of 2.75% (p = .916). Conclusions: The rates of SSI in patients undergoing combined breast surgery and hysterectomy is not significantly different from breast surgery or hysterectomy alone. Gynecologic oncologist should coordinate with breast surgeons to perform a combined procedure in patients who require both breast surgery and hysterectomy.

scholarly journals Cost-effectiveness of total laparoscopic hysterectomy and non-descent vaginal hysterectomy versus total abdominal hysterectomy: a multi-centre randomized controlled trial

2019 ◽  
Author(s):  
Chanil Deshan Ekanayake ◽  
Arunasalam Pathmeswaran ◽  
Sanjeewa Kularatna ◽  
Rasika Herath ◽  
Prasantha Wijesinghe
Keyword(s):  
Randomized Controlled Trial ◽  
Cost Effectiveness ◽  
Vaginal Hysterectomy ◽  
Controlled Trial ◽  
Laparoscopic Hysterectomy ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Total Laparoscopic Hysterectomy ◽  
Randomized Controlled ◽  
Clinical Trials Registry

Abstract Background: Hysterectomy is the most common major surgical procedure in gynaecology. The methods in mainstream practice are; total abdominal hysterectomy (TAH), non-descent vaginal hysterectomy (NDVH) and total laparoscopic hysterectomy (TLH). Most patients requiring hysterectomy for benign gynaecological conditions can be operated using one of these methods. The aim of this study was to study cost-effectiveness of NDVH, TLH and TAH in a low resource setting. Methods: A pragmatic multi-centre three arm (parallel groups) RCT was done in the professorial gynaecology unit of the North Colombo Teaching Hospital, Ragama and the gynaecology unit of the District General Hospital, Mannar, Sri Lanka. Participants were patients requiring hysterectomy for non-malignant uterine causes. Exclusion criteria were uterus>14 weeks, previous pelvic surgery, medical illnesses which contraindicate laparoscopic surgery, and those requiring incontinence surgery or pelvic floor surgery. The main outcome measures were time to recover and cost. The willingness-to-pay (WTP) threshold was set at USD 1000. Results: There was no significant difference in median time to recover (inter quartile range) among TAH, NDVH and TLH which was 35 (30-45), 32 (24.5-60) and 30 (25.5-45) days respectively (p=0.37). The difference in area under the curve for quality adjusted life years (QALYs) was 1.33 and 5.21 for NDVH and TLH compared to TAH. The direct cost (median, interquartile range) of a TLH [USD 349 (322-378)] was significantly higher compared to TAH [USD 289 (264-307)] and NDVH [USD 279 (255-305)]. The incremental cost-effectiveness ratio (ICER) for TLH was USD 12/day whereas NDVH showed a net benefit as both costs and median effect were superior to TAH. The incremental cost utility ratio (ICUR) for TLH and NDVH were 12 and 38 USD/QALY. The ICUR for TLH compared to NDVH was USD 3/per QALY. The net monetary benefit (NMB) was USD 4897 and USD 1264 for TLH and NDVH respectively. Conclusion: Despite there being only a marginal difference among the three routes when considering time to recover, a cost-effectiveness approach using ICER, ICUR and NMB shows that alternate routes, NDVH and TLH to be superior to the conventional TAH. Trial Registration: Sri Lanka clinical trials registry, SLCTR/2016/020 and the International Clinical Trials Registry Platform, U1111-1194-8422, on 26 July 2016. Available from: http://slctr.lk/trials/515. Keywords: Non-descent vaginal hysterectomy, total laparoscopic hysterectomy, total abdominal hysterectomy, cost-effectiveness, randomized controlled trial.

scholarly journals LAPAROSCOPIC HYSTERECTOMY

2016 ◽  
Vol 23 (02) ◽  
pp. 166-170
Author(s):  
Zohra Kahnum ◽  
Amna Kahnum ◽  
Aman ur Rehman ◽  
Liaqat Ali
Keyword(s):  
Vaginal Hysterectomy ◽  
Operating Time ◽  
Laparoscopic Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Minimal Invasive ◽  
Safe Procedure ◽  
Laparoscopic Assisted Vaginal Hysterectomy ◽  
Proper Training ◽  
Laparoscopic Assisted ◽  
Routine Procedures

Introduction: In current era, the trend for minimal invasive surgery is increaseddue to its established advantages. With the same, there increasing trend for laparoscopichysterectomy. But it carries certain risks in certain situations. Objectives: The study wasconducted to see the outcome of laparoscopic hysterectomies. Study Design: Retrospective,analytic study. Study Period: June 2012 to May, 2015. Method: A study was conducted to reviewthe outcome of Laparoscopic hysterectomy over a period of three years from June 2012 to May2015. Total one hundred cases were included in the study. These patients had hysterectomyeither total laparoscopic hysterectomy or laparoscopic assisted vaginal hysterectomy. Afterpreoperative evaluation, hysterectomy was done either total laparoscopic or laparoscopicassisted vaginal hysterectomy. Data was collected regarding patients profile variables,indications for hysterectomy, intraoperative findings, intraoperative time, postoperative recoveryfindings, analgesia requirements and discharge time from the hospital. Results: Results of thestudy showed that there was no significant increase in complication of urinary tract or bowelinjury. Operative time was decreased with time. Most common indication for hysterectomywas fibroid uterus or dysfunctional uterine bleeding. Patient recovery was smooth and postoperativeanalgesia was much less as compared to the routine. Patient hospital stay was lessas compared to the routine procedures for hysterectomy. Conclusion: It is concluded fromthe study that laparoscopic hysterectomy is safe procedure with the clear advantages for thepatient. In the study complication rate, operating time was comparable to the already publishedstudies. With proper training it is acceptable alternate to abdominal hysterectomy with clearadvantages for the patient.

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