Corneal abrasion in hysterectomy and prostatectomy: role of laparoscopic and robotic assistance.
BACKGROUND
Radical prostatectomy (RP) is most commonly performed laparoscopically with a robot (robotic-assisted laparoscopic radical prostatectomy, R/PROST). Hysterectomy, which may be open hysterectomy (O/HYST) or laparoscopic hysterectomy (L/HYST), has been increasingly frequently done via robot (R/HYST). Small case series suggest increased corneal abrasions (CAs) with less invasive techniques.


METHODS
The authors identified RP (166,942), O/HYST (583,298), or L/HYST (216,890) discharges with CA in the Nationwide Inpatient Sample (2000-2011). For 2009-2011, they determined odds ratios (ORs) and 95% confidence intervals (CIs) for CA, in R/PROST, non-R/PROST, L/HYST, O/HYST, and R/HYST. Uni- and multivariate models studied CA risk depending on surgical procedure, age, race, year, chronic illness, and malignancy.


RESULTS
In 2000-2011, 0.18% RP, 0.13% L/HYST, and 0.03% O/HYST sustained CA. Compared with 17,554 non-R/PROSTs (34 abrasions, 0.19%) in 2009-2011, OR was not significantly higher in 28,521 R/PROSTs (99, 0.35%; OR 1.508; CI 0.987 to 2.302; P < 0.057). CA significantly increased in L/HYST (70/51,323; 0.136%) versus O/HYST (70/191,199; 0.037%; OR 3.821; CI 2.594 to 5.630; P < 0.0001), further increasing in R/HYST (63/21, 213; 0.297%; OR 6.505; CI 4.323 to 9.788; P < 0.0001). For hysterectomy, risk of CA increased with age (OR 1.020; CI 1.007 to 1.034; P < 0.003) and number of chronic conditions (OR 1.139; CI 1.065 to 1.219; P < 0.0001). CA risk was likewise elevated in R/HYST with number of chronic conditions. Being African American significantly decreased CA risk in R/PROST and in R/HYST or L/HYST.


CONCLUSIONS
L/HYST increased CA nearly four-fold, and R/HYST approximately 6.5-fold versus O/HYST. Identifiable preoperative factors are associated with either increased risk (age, chronic conditions) or decreased risk (race).
From the Department of Neurology, Northwestern Memorial Hospital, Chicago, Illinois (A.S.); Department of Anesthesia and Critical Care (I.P., D.B.G., S.R.), Department of Obstetrics and Gynecology (N.K.L., M.T.), and Section of Urology, Department of Surgery (S.E.), The University of Chicago Medicine, Chicago, Illinois; and Department of Health Studies (R.K.) and The Center for Health and Social Sciences (S.R.), The University of Chicago, Chicago, Illinois.
Ajay
A
Sampat
Isaac
I
Parakati
Rangesh
R
Kunnavakkam
David B
DB
Glick
Nita K
NK
Lee
Meaghan
M
Tenney
Scott
S
Eggener
Steven
S
Roth
D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D065306:Corneal Injuries / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000601:surgery; D012307:Risk Factors; D012371:Robotics