Infectious Morbidity Risk of Laparoscopic Myomectomy Concomitant Hysteroscopy: A National Surgical Quality Improvement Program (NSQIP) Analysis

OBJECTIVE: We aimed to determine whether hysteroscopy at the time of laparoscopic myomectomy significantly increased the risk of surgical site infection (SSI). DESIGN: A cohort from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) retrospective database. The primary outcome was any surgical site infection within 30 days postoperatively. Further analysis of superficial, deep, and organ space infections was individually performed. Secondary outcome was postoperative urinary tract infection (UTI). Multivariate logistic regression was used to control for other risk factors for surgical site infection. The study was IRB exempt. SETTING: The ACS NSQIP database is a national validated database from academic and community hospitals. PARTICIPANTS: Individuals who had a laparoscopic myomectomy in the years 2015 to 2023. INTERVENTIONS: Laparoscopic myomectomy alone versus laparoscopic myomectomy with concomitant hysteroscopy. MEASUREMENTS AND MAIN RESULTS: The addition of hysteroscopy was not associated with a significant difference in the rates of any SSI (aOR 0.82; 95% CI 0.56-1.17, p = .3), superficial SSI (aOR 0.76, 95% CI 0.48-1.14, p = .2), deep SSI (aOR 1.59, 95 % CI 0.08-10.4, p = .7), organ space SSI (aOR 1.23, 95% CI 0.52-2.20, p = .7), or postoperative UTI (aOR 0.69, 95% CI 0.34-1.24, p = .2) controlling for age, body mass index, American Society of Anesthesiologists Physical Status class, tobacco use, diabetes, blood transfusion, operative time, inpatient versus outpatient procedure, race, and presence of endometriosis. CONCLUSION: After controlling for baseline comorbidities and surgical complexity, concomitant hysteroscopy with laparoscopic myomectomy does not significantly increase 30-day rates of SSIs or postoperative UTIs.