Hysterectomy for non-prolapsed uterus in elderly patients: predictors of prolonged hospital stay

Objective: To investigate surgical outcomes and complications of hysterectomy for benign conditions other than prolapse in elderly patients and to define predictors of prolonged hospitalization. Design: Retrospective analysis of prospectively-collected data. Setting: Academic research center Patients: We utilized our institution surgical database to identify patients aged 60 years or more ("elderly") who underwent hysterectomy for benign conditions other than pelvic organ prolapse during a 20-year period (January 2000 - December 2019). Methods: Length of stay (LOS) of more than 2 days (90th percentile of LOS) was defined as prolonged hospitalization. Patient demographics, comorbid conditions, and surgical approach (vaginal hysterectomy (VH), laparoscopic hysterectomy (LH) and abdominal hysterectomy (AH)) were identified. Patients treated via LH or VH were also grouped as minimally invasive surgery (MIS). Multivariable logistic regression was used to identify factors associated with prolonged LOS. Results: Overall, 334 patients were included in this study, 262 (78.4%) of whom underwent LH, 42 (12.6%) VH and 30 (9.0%) AH. Median LOS was 2 days (1-8), and 63 (18.8%) patients required prolonged LOS. Compared to AH, median hospital stay was shorter in MIS group (2 days vs. 3 days, p<0,001). No admission variables were associated with prolonged LOS. The only independent predictors of prolonged LOS were AH (Odds ratio 24.82, 95%CI 4.84-127.16) and operative time (Odds ratio for 30mins-increased 11.34, 95%CI 1.63-78.78). Compared to those who underwent VH, patients having LH had a higher rate of concomitant salpingo-oophorectomy (96.6% vs. 61.9%, p<0.001). Limitations: retrospective single-center study design, number of patients with prolonged hospitalization, setting (tertiary minimally invasive gynecology referral center) which might have reduced the generalizability of our results. Conclusions: The abdominal route of hysterectomy was found as the main driver of prolonged hospitalization, reinforcing the benefits of MIS for benign hysterectomy in elderly patients with non-prolapsed uteri; the higher chance of performing concomitant salpingo-oophorectomy supports the laparoscopic approach as the first option for these patients.