Hysterectomies Completed in General Gynaecology: Can We Predict Likelihood of a Surgical Complication?

Study Objective To determine hysterectomy complication rate and patient, surgical and provider factors associated with complications. Design Retrospective review Setting 5 Toronto hospitals Patients or Participants Patients undergoing hysterectomy from July 2016-December 2017 Interventions Hysterectomy procedure Measurements and Main Results Retrospective review of Generalist hysterectomies at 5 Toronto hospitals from July 2016 to Dec 2017. Data was extracted from health records coding (ICD-10) and electronic medical records. Complications (in-hospital to 30 days of discharge) were classified using Clavien-Dindo Scale. Patient characteristics (BMI, anemia status), surgical factors (technicity, uterine presence of endometriosis and adhesions, uterine weight) and provider characteristics (case volume) were obtained. Logistic models were used to evaluate variables associated with complications. 1328 hysterectomy cases were performed by 67 surgeons over 1.5 years. The 294 recorded complications were classified as: 119 (40%) Grade 1, 102 (35%) Grade 2, 12 (4%) Grade IIIA, 61 (21%) Grade IIIB. Presence of endometriosis increased odds of any complication (OR 1.87, 95%CI 1.05-3.35, p=0.035). For every 100g increase in uterine weight, odds of ≥ Grade II complication increased by 4.5% (95%CI 0.3% - 9.4%, p=0.035). Low volume surgeons (≤1 hysterectomy/month) had higher unadjusted complication rate (28.6% vs 15.3%, p=0.01). After adjusting for case complexity (composite score incorporating BMI, presence of adhesions, endometriosis and uterine weight) and technicity, low volume surgeons had 2.21 OR (95% CI 1.08 – 4.52, p=0.03) of having ≥ Grade II complication. Conclusion Endometriosis and uterine weight increase risk of hysterectomy complications. Low volume surgeons perform more challenging hysterectomies and have lower technicity rates. After adjusting for patient and surgical factors, low volume surgeons have higher odds of complications.