Evaluating Outcomes of Benign Hysterectomy in the Presence or Absence of Complex Surgical Features

Objective: This study evaluated outcomes following hysterectomies performed for benign indications in surgeries that meet criteria for complexity, compared to those that did not. Materials and Methods: This retrospective study of hysterectomies performed for benign indications compared outcomes in surgeries deemed complex versus noncomplex . Surgery was defined as complex if one or more of the following factors were present: uterine weight >250 g; surgical history of 2 prior cesarean deliveries; or prior laparoscopy or laparotomy for abdominal myomectomy, endometriosis resection, lysis of adhesions, or other surgery on a pelvic organ. Surgeon-level factors were evaluated, including minimally invasive hysterectomy (MIH) use, postoperative length of stay (LOS), and complication rates. Results: From January 2017 to August 2021, 833 women had hysterectomies for benign indications; 603 hysterectomies were complex. These hysterectomies by low-volume surgeons were more likely to have complications than by high-volume surgeons (15.6% versus 5.4%; p < 0.001). These operations by high-volume surgeons were more-frequently MIH (83.4% versus 48.7%; p = 0.009), had fewer blood losses ≥500 mL (1.2% versus 8.0%; p < 0.001), and were less likely to need overnight admissions (74.9% versus 94.5%; p < 0.001). Conclusions: Complex hysterectomies performed for benign indications by high-volume gynecologic surgeons lead to fewer complications and shorter LOS, and are more likely to be performed with a minimally invasive approach. (J GYNECOL SURG 39:229)