The objective of this study was to compare the morbidity of vaginal versus laparoscopic hysterectomy when performed with uterosacral ligament suspension (USLS).
Retrospective propensity-matched cohort study.
American College of Surgeons National Surgical Quality Improvement Program database.
We included all patients who underwent USLS and concurrent total vaginal hysterectomy (TVH-USLS) or total laparoscopic hysterectomy (TLH-USLS) from 2010 to 2015. We excluded those who underwent laparoscopic-assisted vaginal hysterectomy, abdominal hysterectomy, other surgical procedures for apical pelvic organ prolapse, or had gynecologic malignancy.
We compared 30-day complication rates in patients who underwent TVH-USLS versus TLH-USLS in both the total study population as well as a propensity score matched cohort.
The study population was comprised of 3,349 patients who underwent TVH-USLS and 484 who underwent TLH-USLS. Patients who underwent TVH-USLS had a significantly higher composite complication rate (11.4% vs 6.4%, OR 1.9, 1.3-2.8, p<0.01), and a higher serious complication rate (5.6% vs 3.1%, OR 1.8, 1.1-3.1, p=0.02), which excluded urinary tract infection and superficial surgical site infection. Propensity score analysis was performed and patients were matched at a 1:1 ratio between the TVH-USLS group and the TLH-USLS group. In the matched cohort, patients who underwent TVH-USLS had a higher composite complication rate compared to TLH-USLS (10.3% vs 6.4%, OR 1.7, 95%CI 1.1-2.7, p=0.04), while the rate of serious complications did not differ between groups (4.3% vs 3.1%, OR 1.4, 95%CI 0.7-2.8, p=0.4). On multivariate logistic regression, TVH-USLS remained an independent predictor of composite complications (aOR 1.6, 95%CI 1.0-2.6, p=0.04), but not serious complications (aOR 1.4, 95%CI 0.7-2.8, p=0.3).
In this large national cohort, TVH-USLS was associated with a higher composite complication rate than TLH-USLS, largely secondary to an increased rate of urinary tract infection. After matching, the groups had similar rates of serious complications. This data suggests that TLH-USLS should be viewed as a safe alternative to TVH-USLS.

Copyright © 2020. Published by Elsevier Inc.

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