The Beginning of a Paradigm Shift: Increase in Perioperative Complications Following Vaginal Hysterectomy Compared to Laparoscopic Hysterectomy Using the ACS-NSQIP 2016 to 2019 Database

Study Objective: This study aimed to compare the perioperative outcomes of laparoscopic hysterectomy (LH) and vaginal hysterectomy (VH) between 2016 and 2019. Design: A retrospective cohort study. Setting: National database study. Patients: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients who underwent elective LH or VH between 2016 and 2019. Interventions: Our primary outcome of interest was a composite incidence of perioperative complications. We generated a propensity score using a multiple logistic regression model to adjust for confounding factors and to reduce the selection bias between the 2 groups. We matched patients who underwent elective LH to patients who underwent elective VH on the logit of the propensity score. Measurements and Main Results: Of the 76 706 women in the cohort (2016–2019), 62 124 (80.9%) underwent LH and 14 582 (19.0%) underwent VH. After propensity matching (n = 8991 per group), the results of the matched cohort revealed significant differences in the primary composite outcome. The composite risk of death, complications, reoperation, and readmission was lower among patients who underwent LH than among those who underwent VH, such that the primary composite outcome occurred in 5.62% of LH patients compared to 6.65% of VH patients (relative risk [RR] 0.845, 95% confidence interval (CI) 0.753–0.947, p = .004). In addition, the risk of both transfusion and readmission was higher among patients who underwent VH than among those who underwent LH (transfusion: RR 1.372, 95% CI 1.078–1.745, p = .010; readmission: RR 1.546, 95% CI 1.216–1.966, p = .001). Conclusion: We have found that there is a lower 30-day composite morbidity for patients when undergoing LH compared to VH. These data demonstrate a higher risk of perioperative complications in women undergoing VH and should further inform a surgeon's surgical considerations when deciding the optimal route of hysterectomy, depending on the expertise of the surgeon.