Evidence map›Paper›PMID 31482352›Full record

ArticleSurgical endoscopy2020

Impact of prior hysterectomy on surgical outcomes for laparoscopic adnexal surgery.

Roa A Alammari, Elisa M Jorgensen, Anna M Modest, Jennifer Chu, Louise P King, Christopher S Awtrey

Abstract read
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In one paragraph

Article in Surgical endoscopy, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. When Things Go Wrong: A Guide to the Medical, Ethical, and Legal Dimensions of Surgical Complications.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2024
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Roa A AlammariDepartment of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center & Harvard Medical School, 330 Brookline Ave, Kirstein 3, Boston, MA, 02215, USA.
Elisa M JorgensenDepartment of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center & Harvard Medical School, 330 Brookline Ave, Kirstein 3, Boston, MA, 02215, USA.
Anna M ModestDepartment of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center & Harvard Medical School, 330 Brookline Ave, Kirstein 3, Boston, MA, 02215, USA.
Jennifer ChuDepartment of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center & Harvard Medical School, 330 Brookline Ave, Kirstein 3, Boston, MA, 02215, USA.
Louise P KingDepartment of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center & Harvard Medical School, 330 Brookline Ave, Kirstein 3, Boston, MA, 02215, USA.
Christopher S AwtreyDepartment of Obstetrics & Gynecology, Beth Israel Deaconess Medical Center & Harvard Medical School, 330 Brookline Ave, Kirstein 3, Boston, MA, 02215, USA. cawtrey@bidmc.harvard.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAdnexal surgery is believed to be more complex in patients with prior hysterectomy; however, there is little data regarding surgical outcomes. Understanding of individualized risks improves counseling, informed consent, and preoperative planning.

methodsWe performed a retrospective cohort study with a control group; we evaluated 744 patients undergoing laparoscopic adnexal surgery at an academic tertiary care center from 2011 to 2015. Comparisons were made using Chi square, Fisher's exact, or Wilcoxon-rank sum tests. We used log-binomial regression to calculate risk ratio and 95% confidence interval.

resultsPatients with prior hysterectomy were more likely to have intraoperative or postoperative complications at the time of laparoscopic adnexal surgery when compared to patients without prior hysterectomy [17.7% vs. 10.2%, p = 0.02, risk ratio (RR) 1.7, 95% confidence interval (CI) 1.1-2.7]. Patients with prior hysterectomy were four times more likely to have intraoperative complications (3.2% vs. 0.8%, p = 0.047, RR 4.0, 95% CI 1.1-14.7), and five times more likely to have conversion to laparotomy (5.6% vs. 1.1%, p = 0.004, RR 5.0, 95% CI 1.8-14.0). Patients with prior hysterectomy were more likely to need additional procedures, including lysis of adhesions (69.4% vs. 26.0%, p < 0.001), ureterolysis (15.3% vs. 4.8%, p < 0.001), and cystoscopy (28.2% vs. 8.1%, p < 0.001). They had longer operative time [101.5 min (IQR 59.5-135.0) vs. 78.0 min (IQR 53.0-109.0, p < 0.001)], and were less likely to have outpatient surgery (56.5% vs. 84.8%, p < 0.01). Postoperative complications were also more common (15.3% vs. 9.4%, p = 0.046).

conclusionsPatients with prior hysterectomy were 70% more likely to have a complication at the time of laparoscopic adnexal surgery than patients without hysterectomy. Increased risk of complications in subsequent adnexal surgery may influence the informed consent process or decisions regarding ovarian conservation. Awareness of potential need for additional surgical procedures may guide availability of equipment, choice of operating site, or referral to an advanced pelvic surgeon.

Indexed as

HysterectomyAdnexal DiseasesAdnexa UteriAdultCase-Control StudiesConversion to Open SurgeryFemaleHumansIntraoperative ComplicationsLaparoscopyLaparotomyMiddle AgedOdds RatioOperative TimePostoperative ComplicationsRetrospective StudiesAdnexal surgeryGynecologic surgeryHysterectomyOophorectomyOvarian cystPerioperative complications

Identifiers

PMID31482352

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.