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Infectious Morbidity Risk of Laparoscopic Myomectomy Concomitant Hysteroscopy: A National Surgical Quality
Anna J Najor1, Sarah Thappa1, Eung-Mi Lee1
1Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecological Surgery, Weill Cornell Medicine (all authors), New York, New York.
Objective:
We aimed to determine whether hysteroscopy at the time of laparoscopic myomectomy significantly increased the risk of surgical site infection (SSI).
Design:
A cohort from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) retrospective database. The primary outcome was any surgical site infection within 30 days postoperatively. Further analysis of superficial, deep, and organ space infections was individually performed. Secondary outcome was postoperative urinary tract infection (UTI). Multivariate logistic regression was used to control for other risk factors for surgical site infection. The study was IRB exempt.
Setting:
The ACS NSQIP database is a national validated database from academic and community hospitals.
Participants:
Individuals who had a laparoscopic myomectomy in the years 2015 to 2023.
Interventions:
Laparoscopic myomectomy alone versus laparoscopic myomectomy with concomitant hysteroscopy.
Measurements And Main Results:
The addition of hysteroscopy was not associated with a significant difference in the rates of any SSI (aOR 0.82; 95% CI 0.56-1.17, p = .3), superficial SSI (aOR 0.76, 95% CI 0.48-1.14, p = .2), deep SSI (aOR 1.59, 95 % CI 0.08-10.4, p = .7), organ space SSI (aOR 1.23, 95% CI 0.52-2.20, p = .7), or postoperative UTI (aOR 0.69, 95% CI 0.34-1.24, p = .2) controlling for age, body mass index, American Society of Anesthesiologists Physical Status class, tobacco use, diabetes, blood transfusion, operative time, inpatient versus outpatient procedure, race, and presence of endometriosis.
Conclusion:
After controlling for baseline comorbidities and surgical complexity, concomitant hysteroscopy with laparoscopic myomectomy does not significantly increase 30-day rates of SSIs or postoperative UTIs.
Insights
Adding hysteroscopy to laparoscopic myomectomy does not increase surgical site infection (SSI) or urinary tract infection (UTI) risk. This finding holds true after accounting for patient factors and surgical complexity, ensuring patient safety.
Area of Science:
- Gynecology
- Surgical Oncology
- Infectious Disease
Background:
- Laparoscopic myomectomy is a common procedure for uterine fibroids.
- Concomitant hysteroscopy is sometimes performed during laparoscopic myomectomy.
- The impact of combined procedures on surgical site infection (SSI) risk is not well-established.
Purpose of the Study:
- To evaluate if performing hysteroscopy concurrently with laparoscopic myomectomy increases the risk of surgical site infections (SSIs).
- To assess the association between combined hysteroscopy and laparoscopic myomectomy and postoperative urinary tract infection (UTI) rates.
Main Methods:
- Retrospective cohort study using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database (2015-2023).
- Compared outcomes for patients undergoing laparoscopic myomectomy alone versus those with concomitant hysteroscopy.
- Analyzed rates of any SSI, superficial SSI, deep SSI, organ space SSI, and postoperative UTI.
- Utilized multivariate logistic regression to control for confounding variables.
Main Results:
- The addition of hysteroscopy was not significantly associated with an increased risk of any SSI (aOR 0.82; P=0.3).
- No significant differences were observed in superficial SSI, deep SSI, organ space SSI, or postoperative UTI rates between the groups.
- These findings remained consistent after adjusting for multiple patient and surgical factors.
Conclusions:
- Concomitant hysteroscopy during laparoscopic myomectomy does not significantly elevate the risk of 30-day SSIs.
- The combined procedure does not appear to increase the likelihood of postoperative UTIs.
- This suggests that performing hysteroscopy concurrently with laparoscopic myomectomy is a safe practice regarding infection risk.
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