Easy-to-use tool predicts complications in patients undergoing hysterectomy for benign disease

Researchers have developed easy-to-use online prediction tools that provide personalized risk assessment for patients undergoing hysterectomy for benign disease. A study describing the models is published in CMAJ (Journal of the Canadian Medical Association).

A hysterectomy is one of the most common surgical procedures, with one-third of women in Canada undergoing the procedure before the age of 60. Laparoscopic hysterectomies are performed more often because they are less invasive than abdominal surgery. Current practice involves surgeons discussing with patients the benefits of the type of procedure and the risks of complications.

Researchers from the UK and Spain developed and tested predictive models to supplement surgeons’ expert judgment about which patients may be at risk of complications after hysterectomy. Complications of hysterectomy can include damage to the ureter, gastrointestinal tract, and blood vessels, as well as wound complications. The authors used data from England’s National Health Service (NHS) on 68,599 women who underwent laparoscopic hysterectomy and 125,971 women who underwent abdominal hysterectomy between 2011 and 2018.

“Historically, surgeon well-being is a good predictor of postoperative outcomes; however, expert opinion is the lowest value in evidence-based medicine,” says Dr. Krupa Madhwani of Queen Mary University of London, UK. “Although surgeon experience and expert opinion are useful, they should not be used solely for risk management. In Canada and around the world, the overall rate of hysterectomies for benign disease is declining, and more patients are undergoing smaller surgeries surgeonswho may not be experienced in each procedure,” the authors write.

Using 11 predictors such as age, body mass index and diabetes, the researchers also included ethnicity as a potential risk factor, classifying sick people‘ self-description of ethnicity related to a recent census.

“Ethnicity has been shown to be an independent factor influencing the course and complications of hysterectomy,” the authors write.

They found that women of Asian descent were at greater risk of serious complications after cesarean hysterectomy compared with white women, although the risk was not associated with laparoscopy. The most significant risk factor for major complications in both procedures was the presence of adhesions, which is consistent with existing data.

“These tools will guide shared decision making and may lead to referrals to centers with greater surgical expertise or exploration of nonsurgical treatment options,” the authors write.