BACKGROUND AND PURPOSE:

• Coyne et al. (Fertility and Sterility, 2023) assessed the risk of hysterectomy at the time of myomectomy

METHODS:

• Retrospective cohort study
  • Data from the American College of Surgeons’ National Surgical Quality Improvement Program
• Population
  • Underwent myomectomies between 2010 and 2021
• Exposure
  • Unplanned hysterectomy at the time of a myomectomy
• Study design
  • Univariate analysis used to identify risk of unplanned hysterectomy
  • Multivariate logistic regression analysis used to determine risk factors for hysterectomy at the time of myomectomy
• Primary outcome
  • Risk of unplanned hysterectomy and risk factors

RESULTS:

• 13,213 individuals underwent myomectomy
  • Underwent hysterectomy during myomectomy: 3.0%
• Mode of concurrent hysterectomy
  • Laparoscopic approach: 7.1%
  • Abdominal approach: 3.2%
  • Hysteroscopic: 1.9%
• Risk factors associated with significantly increased risk of hysterectomy at time of myomectomy
  • Age ≥43 years
  • Obesity
  • American Society of Anesthesiologists (ASA) class greater than II
  • Tobacco use
  • Longer operative time (>85 minutes)
  • Laparoscopic approach
• After adjustment, an increased odds of hysterectomy was found for
  • White race
  • Longer operative time
  • ≥ASA class III
  • Obesity
  • Laparoscopic approach
  • Low fibroid burden
• Patients who underwent concurrent hysterectomy had
  • Longer median length of hospital stay
    • Hysterectomy: 2 days | No hysterectomy: 1 day
    Longer median operative time
    • Hysterectomy: 161 minutes | No hysterectomy: 126 minutes
    Increased intraoperative/postoperative blood transfusions
    • Hysterectomy: 14.5% | No hysterectomy: 9.0%
    Higher rates of organ/space surgical site infections
    • Hysterectomy: 1.5% | No hysterectomy: 0.5%
  • Return to surgery
    • Hysterectomy: 2.0% | No hysterectomy: 0.7%
• Patients who underwent concurrent hysterectomy had an increased risk of a major complication within 30 days of myomectomy
  • Adjusted odds ratio (aOR) 2.4 (95% CI, 1.8 to 3.2)

CONCLUSION:

• The incidence of hysterectomy at the time of myomectomy is 3.0%
• Risk factors are white race | Obesity | Age ≥43 years | ASA class III or higher | Longer operative time | Laparoscopic approach
• The authors state

In conclusion, the rate of concurrent hysterectomy during myomectomy is higher than previously described in the literature

In addition to patients wishing to preserve fertility, counseling about this risk of hysterectomy is important for all patients because it is associated with increased short- and long-term morbidities as well as both minor and major complications within 30 days of the procedure

Learn More – Primary Sources:

Risk of hysterectomy at the time of myomectomy: an underestimated surgical risk

Statement on ASA Physical Status Classification System

Related ObG Topics:

What is the Risk of Myomectomy at the Time of Cesarean Section?

What is the Prevalence of Occult Malignancy During Hysterectomy or Myomectomy for Benign Indications?