Using international data to set benchmarks for morbidity outcomes after hysterectomy

To set an international benchmark for monitoring morbidity after hysterectomy. In a retrospective, observational study, data were assessed from women who underwent abdominal, vaginal, or laparoscopic hysterectomy in three countries (Australia, England, and the USA) between 2008 and 2012. The main outcome measures were length of stay (LOS), readmission, hemorrhage, and intraoperative conversion. Overall, 32 181 procedures were included. The intraoperative conversion rate from vaginal and laparoscopic to abdominal hysterectomy was 1.5%. The LOS was significantly higher after abdominal surgery (3 days) than after vaginal (2 days; P < 0.001) or laparoscopic (1 day; P < 0.001) surgery. LOS was also higher after conversion (3 days) than after vaginal and laparoscopic hysterectomy ( P < 0.001 for both). Conversion cases had the highest rate of hemorrhage (7.5% vs 2.4% for abdominal, 1.8% vaginal, and 1.2% laparoscopic) and readmission (5.0% vs 4.2% for abdominal, 3.1% vaginal, and 2.8% laparoscopic). The odds of readmission were higher after abdominal than after laparoscopic hysterectomy (odds ratio 1.41, 95% confidence interval 1.19–1.67; P < 0.001). The morbidity associated with different surgical approaches to hysterectomy, including after intraoperative conversion, should be used as a benchmark. There is a need to measure and publish morbidity data after hysterectomy.