title: Occurrence of and Risk Factors for Urological Intervention During Benign Hysterectomy: Analysis of the National Surgical Quality Improvement Program Database.
abstract: To determine the occurrence of lower genitourinary tract (LGUT) injury during hysterectomy for benign disease and identify risk factors for LGUT injury, with a specific focus on the effect of hysterectomy modality.
  
  
  
  We performed a retrospective cohort study of patients undergoing hysterectomy for benign disease from 2010 t o 2014 using the American College of Surgeons National Surgical Quality Improvement Program, a multi-institutional prospective registry that captures perioperative surgical outcomes. We identified the occurrence of concomitant cystoscopy and therapeutic urologic interventions including endoscopic ureteric stenting, ureteric repair, bladder repair, cystectomy, and urinary diversion as a proxy for LGUT injuries. Adjusted odds ratios and 95% confidence intervals were calculated using multivariate logistic regression.
  
  
  
  We identified 101,021 patients treated with hysterectomy for benign disease: 18,610 (18.4%), 27,427 (27.2%), and 54,984 (54.4%) underwent vaginal, open, and laparoscopic hysterectomy, respectively. Cystoscopy was performed in 16,493 cases (16.3%). There were 2427 patients (2.4%) who underwent concomitant urologic intervention. Patients undergoing laparoscopic hysterectomy had increased occurrence of urologic intervention, excluding cystoscopy (adjusted odds ratio 1.47, 95% confidence interval 1.29-1.69), compared to vaginal hysterectomy; no differences were found between open and vaginal hysterectomy or laparoscopic and open hysterectomy. Larger uteri, a postoperative diagnosis of endometriosis, increasing comorbidity, and African American race were associated with an increased odd of urologic intervention whereas concomitant cystoscopy was associated with a decreased chance.
  
  
  
  The incidence of lower genitourinary tract intervention in benign hysterectomy is significant and may be higher than previously reported. Predisposing patient factors and operative technique are key risk factors.
authors.affiliation: Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
authors.forename: Christopher J D
authors.initials: CJ
authors.lastname: Wallis
authors.affiliation: Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Cheung
authors.affiliation: Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
authors.forename: Alaina
authors.initials: A
authors.lastname: Garbens
authors.affiliation: Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
authors.forename: Jamie
authors.initials: J
authors.lastname: Kroft
authors.affiliation: Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
authors.forename: Lesley
authors.initials: L
authors.lastname: Carr
authors.affiliation: Division of General Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
authors.forename: Avery B
authors.initials: AB
authors.lastname: Nathens
authors.affiliation: Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
authors.forename: Lesley
authors.initials: L
authors.lastname: Po
authors.affiliation: Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Nam
authors.affiliation: Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
authors.forename: Grace
authors.initials: G
authors.lastname: Liu
authors.affiliation: Department of Gynecologic Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
authors.forename: Lilian
authors.initials: L
authors.lastname: Gien
authors.affiliation: Division of Urology, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada. Electronic address: raj.satkunasivam@gmail.com.
authors.forename: Raj
authors.initials: R
authors.lastname: Satkunasivam
mesh_terms: D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D003558:Cystoscopy / Q000009:adverse effects / Q000379:methods; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods*; D015907:Hysteroscopy / Q000009:adverse effects / Q000379:methods; D007049:Iatrogenic Disease; D015994:Incidence; D016015:Logistic Models; D059411:Lower Urinary Tract Symptoms / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D008875:Middle Aged; D015999:Multivariate Analysis; D061646:Operative Time; D058996:Quality Improvement; D012189:Retrospective Studies; D018570:Risk Assessment; D014551:Urinary Tract / Q000293:injuries*; D014591:Uterine Diseases / Q000473:pathology / Q000601:surgery