Incidence of bowel injury during gynecological surgery for benign indications: a nationwide cross-sectional study of cases from 2009 to 2018.

OBJECTIVE To investigate the incidence and risk factors of intestinal injury during gynecological surgery for benign diseases, based on a national database. METHOD The study cohort was generated by extracting patients with operation codes for benign gynecological diseases from the Health Insurance Review & Assessment Service National Inpatient Sample from 2009 to 2018. After analyzing the incidence of bowel injury during gynecological surgery, a multivariate analysis was performed to identify the associated risk factors for bowel injury. RESULTS Among 81,451 patients who underwent gynecological surgery for benign diseases, the incidence of bowel injury was 6.14 per 1,000 women. The risk of bowel injury decreased with laparoscopy (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.41-0.69; p < 0.001) and increased with subtotal hysterectomy (OR, 2.83; 95% CI, 1.79-4.46; p < 0.001) and adnexectomy (OR, 2.83; 95% CI, 1.93-4.16; p < 0.001). Old age, higher Charlson comorbidity index, low socioeconomic status, and a higher clinic grade were associated with a higher risk of bowel injury. CONCLUSION This study revealed the incidence of bowel injury during benign gynecological surgery in a Korean national population-based cohort. The risk of bowel injury increased with open surgery, subtotal hysterectomy, and adnexectomy.