Complication Differences Across Elective, Minimally Invasive, Outpatient Hysterectomy and Myomectomy

Area of Science:

• Gynecology
• Surgical Outcomes
• Urogynecology

Background:

• Uterine fibroids are a common gynecological condition often treated with hysterectomy or myomectomy.
• Minimally invasive surgical techniques are increasingly utilized for these procedures in the outpatient setting.
• Assessing short-term complication rates is crucial for guiding surgical management decisions.

Purpose of the Study:

• To compare 30-day complication rates between minimally invasive myomectomy and minimally invasive hysterectomy.
• To evaluate differences in hospital readmissions and reoperations for these two procedures.
• To determine the optimal surgical approach for elective outpatient management of uterine fibroids.

Main Methods:

• Retrospective cohort study utilizing the American College of Surgeons National Surgical Quality Improvement Program database (2016-2021).
• Inclusion of patients aged 18-50 undergoing elective outpatient minimally invasive hysterectomy or myomectomy for uterine fibroids.
• Propensity-matched analysis comparing outcomes between the two surgical groups.

Main Results:

• A total of 31,203 patients were analyzed, with 14% undergoing myomectomy.
• In a matched analysis of 3,413 pairs, myomectomy was associated with significantly lower odds of 30-day postoperative complications (OR 0.73).
• Myomectomy also demonstrated lower odds of hospital readmission (OR 0.39) and reoperation (OR 0.33) within 30 days.

Conclusions:

• Minimally invasive myomectomy is associated with superior short-term outcomes compared to hysterectomy in elective outpatient settings for leiomyomas.
• The findings suggest that myomectomy may be a preferred surgical option for managing uterine fibroids when fertility preservation or uterine conservation is desired.
• This study highlights the safety and efficacy of minimally invasive myomectomy in the outpatient setting, supporting its broader adoption.