دورية أكاديمية
أعرض في EDS

Hysterectomy Trends and Risk of Vaginal Cuff Dehiscence: An Update by Mode of Surgery.

التفاصيل البيبلوغرافية
العنوان: Hysterectomy Trends and Risk of Vaginal Cuff Dehiscence: An Update by Mode of Surgery.
المؤلفون: Polin M; Department of Obstetrics and Gynecology, Division of Gynecologic Specialty Surgery (Drs. Polin, Boone, Advincula, and H. Hur), Columbia University Irving Medical Center, New York, New York., Boone R; Department of Obstetrics and Gynecology, Division of Gynecologic Specialty Surgery (Drs. Polin, Boone, Advincula, and H. Hur), Columbia University Irving Medical Center, New York, New York., Lim F; Department of Medicine, Columbia University Irving Medical Center (Ms. Lim and Dr. C. Hur), New York, New York., Advincula AP; Department of Obstetrics and Gynecology, Division of Gynecologic Specialty Surgery (Drs. Polin, Boone, Advincula, and H. Hur), Columbia University Irving Medical Center, New York, New York., May B; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center (Mr. May and Dr. C. Hur), New York, New York., Hur C; Department of Medicine, Columbia University Irving Medical Center (Ms. Lim and Dr. C. Hur), New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center (Mr. May and Dr. C. Hur), New York, New York., Hur HC; Department of Obstetrics and Gynecology, Division of Gynecologic Specialty Surgery (Drs. Polin, Boone, Advincula, and H. Hur), Columbia University Irving Medical Center, New York, New York. Electronic address: hye-chun.hur@nyulangone.org.
المصدر: Journal of minimally invasive gynecology [J Minim Invasive Gynecol] 2023 Jul; Vol. 30 (7), pp. 562-568. Date of Electronic Publication: 2023 Mar 14.
نوع المنشور: Observational Study; Journal Article
اللغة: English
بيانات الدورية: Publisher: Elsevier Country of Publication: United States NLM ID: 101235322 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1553-4669 (Electronic) Linking ISSN: 15534650 NLM ISO Abbreviation: J Minim Invasive Gynecol Subsets: MEDLINE
أسماء مطبوعة: Original Publication: Philadelphia, PA : Elsevier, c2005-
مواضيع طبية MeSH: Laparoscopy*/adverse effects, Female ; Humans ; Retrospective Studies ; Hysterectomy/adverse effects ; Hysterectomy, Vaginal/adverse effects ; Vagina/surgery
مستخلص: Study Objective: To analyze hysterectomy trends and vaginal cuff dehiscence (VCD) rates by mode of surgery at a tertiary care medical center and to describe characteristics of VCD cases.
Design: Observational retrospective cohort study.
Setting: Large academic hospital and affiliated community hospital.
Patients: 4722 patients who underwent hysterectomy at Columbia University Irving Medical Center between January 2010 and August 2021.
Interventions: Current Procedural Terminology and International Classification of Diseases codes identified hysterectomies and VCD cases. Hysterectomy trends and VCD rates were calculated by mode of surgery. Relative risks of VCD for each mode were compared with total abdominal hysterectomy (TAH). Clinical characteristics of VCDs were reviewed.
Measurements and Main Results: There were 4059 total hysterectomies. Laparoscopic hysterectomies, including total laparoscopic hysterectomies (TLHs), laparoscopic-assisted vaginal hysterectomies, and robot-assisted TLHs (RA-TLHs), increased from 41.9% in 2010 to 65.9% in 2021 (p <.001). RA-TLH increased from 5.7% in 2010 to 40.2% in 2021. Supracervical hysterectomies followed similar trends and were excluded from VCD analysis. There were 15 VCDs (overall rate 0.37%). VCD was highest after RA-TLH (0.66%), followed by TLH (0.32%) and TAH (0.27%), with no VCDs after laparoscopic-assisted vaginal hysterectomy or total vaginal hysterectomy. Compared with TAH, the relative risk for VCD after RA-TLH was 2.44 (95% confidence interval 0.66-9.00) and after TLH was 1.18 (95% confidence interval 0.24-5.83), which were not statistically significant. The mean time to dehiscence was 39 days (range 8-145 days). The most common trigger event was coitus (41%).
Conclusion: VCD rates were low (<1%) for all modes of hysterectomy, and rates after robotic and laparoscopic hysterectomy were much lower than previously reported. Although VCD rates trended higher after robotic and laparoscopic hysterectomy compared with abdominal hysterectomy, the difference was not significant. It is difficult to determine whether this finding represents true lack of difference vs a lack of power to detect a significant difference given the rarity of VCD.
(Copyright © 2023 AAGL. Published by Elsevier Inc. All rights reserved.)
التعليقات: Comment in: J Minim Invasive Gynecol. 2023 Nov;30(11):933. (PMID: 37574008)
Comment in: J Minim Invasive Gynecol. 2023 Nov;30(11):932-933. (PMID: 37586478)
فهرسة مساهمة: Keywords: Hysterectomy; Laparoscopic hysterectomy; Minimally invasive hysterectomy; Robotic hysterectomy; Surgical complications; Vaginal cuff dehiscence
تواريخ الأحداث: Date Created: 20230315 Date Completed: 20230711 Latest Revision: 20240111
رمز التحديث: 20240111
DOI: 10.1016/j.jmig.2023.03.005
PMID: 36921892
قاعدة البيانات: MEDLINE
الوصف
تدمد:1553-4669
DOI:10.1016/j.jmig.2023.03.005