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Perioperative Complications of Laparoscopic versus Open Surgery for Pelvic Inflammatory Disease.
J Minim Invasive Gynecol. 2020 Sep 04 [Online ahead of print]JM

Abstract

STUDY OBJECTIVE

To compare complications in patients undergoing laparoscopic vs open surgery for acute pelvic inflammatory disease (PID).

DESIGN

We performed a retrospective cohort study of patients who underwent surgery for PID, using the American College of Surgeons National Surgical Quality Improvement Program database from 2010 to 2015. Propensity score matching was used to balance baseline characteristics and compare complications in patients who underwent laparoscopic vs open surgery.

SETTING

Surgical management of acute PID.

PATIENTS

Patients with a preoperative diagnosis of PID were identified using International Classification of Diseases, Ninth Revision, codes. We excluded patients with chronic PID, gynecologic malignancy, and those for whom the surgical route was unknown.

INTERVENTIONS

Surgery for acute PID.

MEASUREMENTS AND MAIN RESULTS

The study included 367 patients. The mean age was 43.0 ± 11.1 years, body mass index was 30.9 ± 11.2 kg/m2, and American Society of Anesthesiology class was 2 (interquartile range 2-3). Preoperative signs of sepsis were noted in 33.8% of the patients, and septic shock was present in 1.4%. Hysterectomy was performed in 67.6%, oophorectomy in 12.0%, and salpingectomy in 4.6%. Complications were experienced by 114 patients (31.1%), 11 (3.0%) of which were potentially life-threatening. Multivariate logistic regression identified the following to be independently associated with complications: laparoscopy (adjusted odds ratio [aOR] 0.48; 95% confidence interval [CI], 0.3-0.8; p <.01), operative time (aOR 1.01; 95% CI, 1.00-1.01; p <.01), appendectomy (aOR 2.36; 95% CI, 1.0-5.4; p = .04), elevated international normalized ratio (aOR 2.30; 95% CI, 1.3-4.2; p <.01), and low hematocrit level (aOR 2.53; 95% CI, 1.4-4.5; p <.01). Propensity scores were calculated and used to generate a matched cohort of patients who underwent laparoscopic vs open surgery; the groups were similar, with p <.05 for all covariates. After balancing confounding variables, a laparoscopic approach to surgery remained significantly associated with a lower risk of complications (coefficient -0.07; 95% CI, -0.11 to -0.02; p = .008).

CONCLUSION

Laparoscopy was associated with lower complication rates than open surgery in this well-matched cohort of patients who underwent surgery for acute PID.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio (all authors). Electronic address: Sonia.carlson@uhhospitals.org.Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio (all authors).Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio (all authors).Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio (all authors).Department of Obstetrics and Gynecology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio (all authors).

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32891823

Citation

Carlson, Sonia, et al. "Perioperative Complications of Laparoscopic Versus Open Surgery for Pelvic Inflammatory Disease." Journal of Minimally Invasive Gynecology, 2020.
Carlson S, Batra S, Billow M, et al. Perioperative Complications of Laparoscopic versus Open Surgery for Pelvic Inflammatory Disease. J Minim Invasive Gynecol. 2020.
Carlson, S., Batra, S., Billow, M., El-Nashar, S. A., & Chapman, G. (2020). Perioperative Complications of Laparoscopic versus Open Surgery for Pelvic Inflammatory Disease. Journal of Minimally Invasive Gynecology. https://doi.org/10.1016/j.jmig.2020.08.488
Carlson S, et al. Perioperative Complications of Laparoscopic Versus Open Surgery for Pelvic Inflammatory Disease. J Minim Invasive Gynecol. 2020 Sep 4; PubMed PMID: 32891823.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Perioperative Complications of Laparoscopic versus Open Surgery for Pelvic Inflammatory Disease. AU - Carlson,Sonia, AU - Batra,Sadhvi, AU - Billow,Megan, AU - El-Nashar,Sherif A, AU - Chapman,Graham, Y1 - 2020/09/04/ PY - 2020/07/10/received PY - 2020/08/26/revised PY - 2020/08/30/accepted PY - 2020/9/7/pubmed PY - 2020/9/7/medline PY - 2020/9/6/entrez KW - Laparoscopy KW - Surgical management KW - Tubo-ovarian abscess JF - Journal of minimally invasive gynecology JO - J Minim Invasive Gynecol N2 - STUDY OBJECTIVE: To compare complications in patients undergoing laparoscopic vs open surgery for acute pelvic inflammatory disease (PID). DESIGN: We performed a retrospective cohort study of patients who underwent surgery for PID, using the American College of Surgeons National Surgical Quality Improvement Program database from 2010 to 2015. Propensity score matching was used to balance baseline characteristics and compare complications in patients who underwent laparoscopic vs open surgery. SETTING: Surgical management of acute PID. PATIENTS: Patients with a preoperative diagnosis of PID were identified using International Classification of Diseases, Ninth Revision, codes. We excluded patients with chronic PID, gynecologic malignancy, and those for whom the surgical route was unknown. INTERVENTIONS: Surgery for acute PID. MEASUREMENTS AND MAIN RESULTS: The study included 367 patients. The mean age was 43.0 ± 11.1 years, body mass index was 30.9 ± 11.2 kg/m2, and American Society of Anesthesiology class was 2 (interquartile range 2-3). Preoperative signs of sepsis were noted in 33.8% of the patients, and septic shock was present in 1.4%. Hysterectomy was performed in 67.6%, oophorectomy in 12.0%, and salpingectomy in 4.6%. Complications were experienced by 114 patients (31.1%), 11 (3.0%) of which were potentially life-threatening. Multivariate logistic regression identified the following to be independently associated with complications: laparoscopy (adjusted odds ratio [aOR] 0.48; 95% confidence interval [CI], 0.3-0.8; p <.01), operative time (aOR 1.01; 95% CI, 1.00-1.01; p <.01), appendectomy (aOR 2.36; 95% CI, 1.0-5.4; p = .04), elevated international normalized ratio (aOR 2.30; 95% CI, 1.3-4.2; p <.01), and low hematocrit level (aOR 2.53; 95% CI, 1.4-4.5; p <.01). Propensity scores were calculated and used to generate a matched cohort of patients who underwent laparoscopic vs open surgery; the groups were similar, with p <.05 for all covariates. After balancing confounding variables, a laparoscopic approach to surgery remained significantly associated with a lower risk of complications (coefficient -0.07; 95% CI, -0.11 to -0.02; p = .008). CONCLUSION: Laparoscopy was associated with lower complication rates than open surgery in this well-matched cohort of patients who underwent surgery for acute PID. SN - 1553-4669 UR - https://www.unboundmedicine.com/medline/citation/32891823/Perioperative_Complications_of_Laparoscopic_versus_Open_Surgery_for_Pelvic_Inflammatory_Disease. L2 - https://linkinghub.elsevier.com/retrieve/pii/S1553-4650(20)30878-5 DB - PRIME DP - Unbound Medicine ER -
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