New Case-Complexity Score for Benign Minimally Invasive Hysterectomy- One Step Beyond the Current CPT Codes [32H]

INTRODUCTION: Evidence has shown several preoperative and intraoperative factors to clearly influence the complexity of minimally invasive hysterectomy. The only factor currently taken into consideration is uterine weight. METHODS: Retrospective cohort analysis of 196 consecutive patients undergoing robotic or laparoscopic hysterectomy for benign indications by fellowship-trained minimally invasive gynecologists at a single urban teaching university hospital. RESULTS: Our regression model predicting operative time using age, race, uterine weight, history of myomectomy, ovarian cystectomy, lysis of adhesions, ureterolysis, excision of endometriosis, and uterine artery ligation was significant (F=16.90, p < .0001) with R2 = .31. The variables that were significantly independently associated with operative time included log uterine weight (p < .0001), history of myomectomy (p=.014), ovarian cystectomy (p=.061), lysis of adhesions (p=.013), and excision of endometriosis (p=.027). Parameter estimates for each of these predictors were used to calculate a complexity score. This score was strongly correlated with operative time (Pearson r = .55, p < .0001). The association of the new complexity score with estimated blood loss (EBL) (Spearman r = .32, p 250 g criterion with operative time, EBL, LOS, and cost decile were .41, .20, .07, and .15. CONCLUSION: In addition to uterine weight, history of myomectomy and numerous concomitant procedure variables (ovarian cystectomy, lysis of adhesions, excision of endometriosis), significantly affect case-complexity. The current model (250 g) does not adequately reflect case complexity.