Researchers have developed easy-to-use online prediction tool which provides personalized risk estimates for patients undergoing hysterectomy for benign disease, as published in ‘Journal of the Canadian Medical Association’ (CMAJ).

Laparoscopic hysterectomy is becoming more common because it is less invasive than abdominal surgery. Current practice involves the surgeon discussing with the patient the benefits of this type of procedure and the risks of complications.

Researchers from the UK and Spain developed and tested a predictive model with the aim of complementing surgeons’ opinions about which patients may be at risk for hysterectomy complications.

Hysterectomy complications

Complications of a hysterectomy can include: ureteral, gastrointestinal and vascular injuries, and wound complications. The authors used data from the UK National Health Service (NHS) on 68,599 women who underwent a laparoscopic hysterectomy and 125,971 women who underwent an abdominal hysterectomy between 2011 and 2018.

“Historically, surgeon visceral sensation has been shown to be a good predictor of postoperative outcome, however, expert opinion is of the lowest value in evidence-based medicine,” said Dr Krupa Madhvani from Queen Mary’s University of London, UK – While surgeon experience and expert opinion is useful, they cannot be used solely to guide risk management.”

Around the world, global rates of hysterectomy for benign disease are decliningand a growing number of patients are being operated on by low-volume surgeons, who may be inexperienced in all procedures,” write the authors.

Using 11 predictors, including age, body mass index and diabetes, the researchers also included ethnicity as a possible risk factor, classifying patients’ self-described ethnicity based on a recent census.

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

They found that Asian women had a higher risk of major complications after abdominal hysterectomy compared with Caucasian women, although the risk was not associated with laparoscopy. The most significant risk factors for major complications in both procedures were presence of adhesionwhich is consistent with the available evidence.

“These tools will guide joint decision making and could lead to referral to centers with greater surgical experience or exploration of non-surgical treatment options,” they said.