Abdominal versus laparoscopic hysterectomies for benign diseases: Evaluation of morbidity and mortality among 465,798 cases

Hysterectomy is the most common major gynecological surgery performed in women. The aim of this study was to compare major morbidity and mortality between abdominal hysterectomy (AH) and laparoscopic hysterectomy (LH) for benign diseases. We performed a retrospective cohort study using the data from Health Cost and Utilization Project Nationwide Inpatient Sample. Women were admitted for hysterectomy for benign diseases between the years 2002 and 2008. In-hospital morbidities and mortalities were identified using the diagnostic and procedural codes classified according to the International Classification of Disease, Ninth Revision, and Clinical Modification. Logistic regression analysis was used to estimate the relationship between the type of hysterectomy and the development of major morbidity and mortality. Of a total 465,798 cases, 389,189 women (83.6 %) underwent AH and the remainders underwent LH (76,609, 16.4 %). The LH group was younger and more likely to be Caucasian than those who underwent AH. Although major morbidities and mortalities were rare, women who underwent LH were less likely to develop thromboembolic events (0.68 % vs. 0.84 %, odds ratio (OR) 0.85 (0.77-0.93)), require blood transfusions (2.4 % vs. 4.7 %, OR 0.58 (0.55-0.61)), and sustain bowel perforation (0.07 % vs. 0.13 %, OR 0.56 (0.42-0.74)). The mortality rate was also lower in the LH group (0.01 %) compared with the AH group (0.03 %, OR 0.48 (0.24-0.95)). Our conclusion was that for benign diseases, laparoscopic hysterectomy is associated with a lower complication rate than abdominal hysterectomy. When possible, hysterectomy performed for benign diseases should be performed with minimally invasive technique.