Complications Following Laparoscopic Hysterectomy With Concomitant Appendectomy: A National Analysis

To evaluate whether concomitant appendectomy during laparoscopic hysterectomy (LH) for benign indications is associated with increased short-term postoperative complications.

This is a retrospective cohort study based on prospectively collected data.

American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.

Women undergoing LH for benign gynecologic indications between 2012 and 2022.

Comparison between patients undergoing LH alone versus LH with concomitant appendectomy. Propensity score matching (1:3) was used to balance covariates, Clavien-Dindo classification was applied to stratify postoperative complications. The primary outcome was the incidence of any postoperative complications occurring within 30 days. Secondary outcomes included total operative time, length of hospital stay, and readmission.

After propensity score matching, 5782 patients were included, 1459 LH with concomitant appendectomy and 4323 LH-only. Concomitant appendectomy was associated with an increase in overall postoperative complications (7.8% vs. 6.2%, p = .037), and higher rate of major complications (3.7% vs. 2.3%, p = .008). Operative time (152.2 vs. 135.3 minutes, p <.001) and hospital stay (1.2 vs. 0.8 days, p = .019) were longer in the appendectomy group. In multivariable regression, concomitant appendectomy remained independently associated with increased odds of any complication (aOR 1.29, 95% CI 1.03-1.63), major complications (aOR 1.63, 95% CI 1.16-2.29). Appendectomy was also associated with increased odds of overnight admission (aOR 1.45, 95% CI 1.22-1.73) and longer hospital stay ≥1 day (aOR 1.61, 95% CI 1.39-1.87) and ≥2 days (aOR 1.36, 95% CI 1.10-1.67).

In our study, concomitant appendectomy during LH was associated with an increase in major postoperative complications, operative time and hospital length of stay. Overall increased risk remains low, and the decision to perform appendectomy should be individualized, considering surgical complexity, intraoperative findings, and the clinical context, including patient-specific risk factors and goals of care.