Postoperative readmissions following laparoscopic and abdominal hysterectomy: a comparison

To quantify the readmission rates for total laparoscopic and total abdominal hysterectomy, as well as identify preoperative, intraoperative, and postoperative risk factors for readmission within 6 weeks of surgery.

A retrospective comparative study was performed using a departmental database to identify all readmissions following total laparoscopic and total abdominal hysterectomy and to assemble a control group. For each patient, the following data were systematically collected: surgery date, age, parity, body mass index, indications for surgery, type of procedure performed, uterine size, number of prior cesarean sections, number of prior laparoscopic abdominal surgeries, number of prior open abdominal surgeries, presence of adhesions at time of hysterectomy, diabetic status, operative time, postoperative hematocrit, intraoperative and postoperative complications, surgeon, use of postoperative antibiotics, postoperative day readmitted, reason for readmission, length of readmission, and whether the patient returned to the operating room during the readmission.

From January 1, 2000 to April 1, 2007, 1,576 total abdominal and 1,198 total laparoscopic hysterectomies were performed at Ochsner Medical Center. Of these, 19 abdominal and 31 laparoscopic hysterectomy patients were readmitted within 6 weeks of surgery. Our control groups consisted of 84 laparoscopic and 53 abdominal hysterectomy patients. A statistically significant difference in readmission rates (1.2% following abdominal hysterectomy vs. 2.7% following laparoscopic hysterectomy) was identified. No correlation between readmission and operative time, adhesive disease, diabetic status, prior cesarean sections, prior open or laparoscopic procedures, postoperative antibiotic use or postoperative hematocrit could be identified. Compared to those undergoing abdominal hysterectomy, those undergoing laparoscopic hysterectomy had more readmissions due to cuff dehiscence and cuff cellulitis for (p  =  0.0146), which is a previously recognized complication of total laparoscopic hysterectomy. We were unable to identify any significant difference in postoperative day of readmission, length of readmission, or return to operating room.

Further investigation would benefit from an expanded study group, which may result in identification of some significance of the studied factors that were not able to be identified in this study.