Complications Following Laparoscopic Hysterectomy With Concomitant Appendectomy: A National Analysis

Area of Science:

• Gynecologic Surgery
• Surgical Outcomes
• Patient Safety

Background:

• Laparoscopic hysterectomy (LH) is a common procedure for benign gynecologic conditions.
• The role of concomitant appendectomy during LH is debated.
• Understanding associated risks is crucial for surgical decision-making.

Purpose of the Study:

• To evaluate the association between concomitant appendectomy and short-term postoperative complications during LH for benign indications.
• To compare complication rates, operative time, and hospital stay between LH alone and LH with appendectomy.

Main Methods:

• Retrospective cohort study using prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.
• Included women undergoing LH for benign gynecologic indications (2012-2022).
• Propensity score matching (1:3) was used to compare outcomes between LH alone and LH with concomitant appendectomy.

Main Results:

• Concomitant appendectomy was linked to higher rates of overall (7.8% vs. 6.2%) and major postoperative complications (3.7% vs. 2.3%).
• Appendectomy also increased operative time (152.2 vs. 135.3 minutes) and hospital stay (1.2 vs. 0.8 days).
• Multivariable analysis confirmed appendectomy's association with increased odds of any complication, major complications, and longer hospital stays.

Conclusions:

• Concomitant appendectomy during LH is associated with increased major postoperative complications, operative time, and hospital length of stay.
• The overall increased risk is low, emphasizing the need for individualized surgical decisions.
• Factors like surgical complexity, intraoperative findings, and patient-specific risks should guide the decision for appendectomy.