Hysterectomy Versus Uterine Preservation at the Time of Pelvic Reconstructive Surgery

To evaluate national trends in apical prolapse surgery with and without uterine preservation using the National Surgical Quality Improvement Program (NSQIP) database.

Based on the International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes, patients diagnosed with uterovaginal prolapse who underwent apical suspensions between 2013 and 2018 were identified, and procedures involving uterine preservation were differentiated from those with concomitant hysterectomy. Patient characteristics and postoperative complications were analyzed.

A total of 16 427 patients met inclusion criteria, with 2235 (13.6%) undergoing uterine-preservation procedures and 14 192 (86.4%) undergoing hysterectomy. Between 2013 and 2018, the rates of uterine preservation ranged from 12.8% to 15.3%, with the last 2 years having significantly lower rates. Patients in the uterine-preservation group were older (62.8 vs. 60.5 y; P < 0.001), had higher BMI (28.4 vs. 28.1 kg/m²; P = 0.018), and were more likely to have diabetes (12.4% vs. 10.5%; P = 0.006) and hypertension (43.4% vs. 38.0%; P < 0.001). These patients also had higher frailty index than hysterectomy patients. Patients in the uterine-preservation group were more likely to have vaginal mesh. There were no differences between the 2 groups in length of stay or postoperative complications. On multivariate logistic regression, older age (adjusted odds ratio [aoR] 1.02; P < 0.001), higher BMI (aOR 1.01; P = 0.009), and use of vaginal mesh (aOR 2.75; P < 0.001) were associated with higher odds of uterine preservation. Uterine preservation decreased operative time by about 30 minutes after controlling for confounders.

Patients with more comorbidities were more likely to undergo uterine-preserving surgeries, which offered reduced operative time and no differences in postoperative complications.