Benign Hysterectomy Operative Times and 30-Day Complications: A Cohort Study

To evaluate the 30-day complication rate among different hysterectomy routes and operative times.

A retrospective cohort study.

American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2019.

A total of 216 621 total cases including total abdominal hysterectomies (TAHs), total vaginal hysterectomies, total laparoscopic-assisted vaginal hysterectomies, and total laparoscopic hysterectomies.

Eligible cases included benign hysterectomies with operative times between 20 minutes and 500 minutes. We excluded cases involving disseminated cancer, emergency surgery, supracervical approaches, or concomitant procedures.

Multivariable logistic regression was used to evaluate the relationship between postoperative complications and operative time for each operative route. Multivariable logistic regression with a linear spline term was used to analyze differences in the association between postoperative complications and operative time below and above threshold operative times. Multivariable logistic regression demonstrated a significant association between operative time and overall complication rates for all hysterectomy routes. Spline logistic regression demonstrated a significant increase in adjusted odds of a complication occurring at or above the thresholds of 100 minutes for TAH.

Patients undergoing a TAH for benign indications had a significantly increased odds of developing a complication within 30 days when operative time exceeded 100 minutes. Operative time may play a larger role in preoperative, intraoperative, and postoperative management than previously recognized for TAH in contrast to other hysterectomy routes.