RESUMEN
STUDY OBJECTIVE: To evaluate whether there are differences in complication rates between laparoscopic myomectomy (LM) and total laparoscopic hysterectomy (TLH) for the treatment of uterine leiomyoma in perimenopausal women. DESIGN: A retrospective cohort study using 1:2 propensity score matching (Canadian Task Force classification II-2). SETTING: American College of Surgeons National Surgical Quality Improvement Program database. PATIENTS: Women between the ages of 40 and 60 years undergoing surgical laparoscopic surgery for uterine leiomyoma between the years 2010 and 2016. INTERVENTIONS: Women were stratified to either LM or TLH at a ratio of 1:2 using propensity score matching. Descriptive statistics were reported as means with standard deviations. Pairwise analysis using the Student t test and chi-square test was performed where appropriate. Multivariable logistic regression was used to identify factors associated with the presence of a complication. MEASUREMENTS AND MAIN RESULTS: After propensity score matching, there were 631 myomectomies and 1262 hysterectomies. The operating time was slightly longer for LM compared with TLH (166.8 ± 90.3 minutes vs 157.9 ± 70.9 minutes, pâ¯=â¯.03). The overall complication rate was 6.3%. There were no differences in complications between the LM and TLH groups (5.9% vs 6.6%, pâ¯=â¯.54). Urinary tract infections were more common in the TLH group (2.3% vs 0.6%, pâ¯=â¯.01). There were no other differences in the rates of specific complications between the 2 groups. On logistic regression, wound class greater than 3 was most strongly associated with a risk of complications (adjusted odds ratio [aOR]â¯=â¯8.89; 95% confidence interval [CI], 1.28-15.87). Other variables associated with an increased risk of complications were conversion to hysterectomy (aORâ¯=â¯5.91; 95% CI, 1.7-9.63), total operating time (aORâ¯=â¯1.05; 95% CI, 1.02-1.07), and length of stay over 1 day (aORâ¯=â¯3.67; 95% CI, 2.31-5.8). CONCLUSION: LM is not associated with an increased risk of complications compared with TLH in women over the age of 40 years undergoing treatment for uterine leiomyomata.