Analysis Of Risk Factors For Complications At The Time Of Total Laparoscopic Hysterectomy And Create A Prediction Model For Complications

Background Hysterectomy is one of the most common surgical methods in obstetrics and gynecology,which is often used to treat benign uterine lesions.With the improvement of minimally invasive technology in gynecology and the improvement of laparoscopic instruments,laparoscopic total hysterectomy has become a mature surgical method.Objective To explore the risk factors for overall complications and severe complications of total laparoscopic hysterectomy,and to establish a risk prediction model for complications.This study aimed to create a prediction tool for gynecologists to assess their patient’s risk of complication preoperatively.Methods This is a retrospective cohort study that included patients who underwent laparoscopic hysterectomy for benign indications between August 2016 and December 2019in the Yichang First People’s Hospital.The clinical data for this study include age,BMI,Parity,history of laparotomy,history of other pelvic surgeries,history of diabetes,history of hypertension,menopause,vaginitis,preoperative anemia,the operative time,intraoperative blood loss,uterine size,gynecologists,etc.The above variables were analyzed by single factor analysis,and the variables with statistical difference were selected for multivariate logistic regression so as to screen out the independent risk factors for complications at the time of laparoscopic hysterectomy and to establish clinical risk prediction model.Clinical data of 156patients who underwent TLH for benign indications in the First People’s Hospital of Yichang from January 2020 to September 2020 were further collected for model validation.The performance of the prediction model was evaluated according to Receiver Operating Characteristic(ROC)and Area Under Curve(AUC).Results 726 patients enrolled this study including 570 of the model group and 156 of the validation group.The overall incidence of complications was similar between the model and validation groups(6.14%vs 6.4%,P=0.901).The multivariate analysis of the model group showedthatBMI≥25Kg/m~2(OR=2.404,95%CI:1.188-4.867),historyof laparotomy(OR=2.985,95%CI:1.463-6.091)and history of other pelvic surgeries(OR=2.272,95%CI:1.078-4.790)were independent risk factors for overall complications.Age≥50 years old,BMI≥25Kg/m~2,history of laparotomy and history of other pelvic surgeries were independent risk factors for severe complications after TLH.The laparoscopic hysterectomy complication predictor model was established based on the risk factors of total complications after TLH,the ROC curve was used to verify the prediction performance of the risk prediction model.The optimal prediction threshold of this model was 0.074.The sensitivity and specificity were 71.43%and 80%,respectively.The area under the ROC curve was 0.818(95%CI:0.734-0.902).Regards to the validation group,the sensitivity and specificity were 80%and 78.8%,respectively.The AUC was 0.8(95%CI:0.62-0.98),which suggested that the present risk predictive model has a good accuracy.Conclusion BMI≥25Kg/m~2,history of laparotomy and history of other pelvic surgeries were risk factors for overall postoperative complications of TLH.Age≥50 years old,BMI≥25Kg/m~2,history of laparotomy and history of other pelvic surgeries were risk factors for serious complications after TLH.Despite the limitations,the risk prediction model of postoperative complications established in this study has a good predictive performance and can predict the risk of postoperative complications,which will help for gynecologists to screen out high-risk patients and choose appropriate surgical paths,and improve surgical safety.