Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Mar 20, 2023; 13(2): 18-25
Published online Mar 20, 2023. doi: 10.5662/wjm.v13.i2.18
Urinary tract injury during hysterectomy: Does surgeon specialty and surgical volume matter?
Emilee Khair, Fareeza Afzal, Sanjana Kulkarni, Beaux Duhe', Karen Hagglund, Muhammad Faisal Aslam
Emilee Khair, Fareeza Afzal, Sanjana Kulkarni, Muhammad Faisal Aslam, Department of Obstetrics and Gynecology, Ascension St John, Detroit, MI 48236, United States
Beaux Duhe', Department of Obstetrics and Gynecology, St. George's University School of Medicine, Great River, NY 11739, United States
Karen Hagglund, Department of Medical Research, Ascension St John, Detroit, MI 48236, United States
Author contributions: Khair EL designed the study, collected data, and wrote and edited the manuscript; Afzal F, Kulkarni SP, and Duhe’ BJ collected data for the manuscript; Hagglund K analyzed the data for the manuscript; Aslam MF edited the manuscript and assisted in study design; All authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewer. IRB Reference number: 1820585.
Informed consent statement: The study is a retrospective study and therefore informed consent was not obtained, as it was exempt by the IRB.
Conflict-of-interest statement: We have no conflicts of interest to disclose and there has been no financial support for this research that could have influenced the outcome. As the corresponding author, I confirm that the manuscript has been reviewed and approved for submission by all authors.
Data sharing statement: Statistical code and dataset are available from Emilee Khair, MD at Consent was not obtained but the presented data are anonymous and risk of identification was low.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Emilee Khair, MD, Doctor, Department of Obstetrics and Gynecology, Ascension St John, 22101 Moross Rd, Detroit, MI 48236, United States.
Received: October 30, 2022
Peer-review started: October 30, 2022
First decision: January 20, 2023
Revised: February 2, 2023
Accepted: February 13, 2023
Article in press: February 13, 2023
Published online: March 20, 2023
Research background

It is well known that urinary tract injury is a complication of hysterectomies. There have been many studies that aim to determine if surgeon volume has an impact on the incidence urinary tract injury during hysterectomies. However, no studies have compared subspecialists to general gynecologists when assessing the incidence of urinary tract injury.

Research motivation

Urinary tract injury increases morbidity for patients who undergo hysterectomy. Subspeciality training and surgeon volume are factors that should be assessed when determining the incidence of urinary tract injury in an effort to decrease patient morbidity.

Research objectives

Our primary outcome was the incidence of urinary tract injury between fellowship trained board-certified female pelvic medicine and reproductive surgery surgeon, fellowship trained board eligible or board-certified gynecologic oncology surgeons, and board-certified or board eligible general gynecologists. Our secondary outcome was the incidence of urinary tract injury between high (defined by 30 or more minimally invasive hysterectomies per year) and low-volume surgeons (defined by less than 30 hysterectomies per year).

Research methods

We conducted a retrospective chart review of adult patients who underwent minimally invasive hysterectomy. All patients who underwent the following surgeries with or without concomitant procedures were included: Laparoscopic supracervical hysterectomy, laparoscopic assisted vaginal hysterectomy, total laparoscopic hysterectomy, and robotic hysterectomy. After we identified eligible patients, the surgeon subspecialty was identified and the surgeon’s volume per year was calculated. Univariable analysis of factors associated with surgeon type and ureteral injury were assessed using Student’s t-test, ANOVA followed by multiple pairwise comparisons using the Bonferroni correction of the P value, and the χ2 analysis. Non-parametric tests were performed for data that were non-normally distributed, such as the Mann-Whitney U test and Kruskal-Wallis test.

Research results

Urologic injury occurred in four patients (2%) in the general gynecologist group, in one patient (1%) in the gynecologic oncologist group, and in one patient (1%) in the urogynecologist group. Bowel injury occurred in three (3%) of patients in the gynecologic oncologist group and there were none in the general gynecologist and urogynecologist groups. There were no cases of major vessel injury.

Research conclusions

When comparing high and low-volume surgeons, there was no statistically significant difference in urinary tract injury (1% vs 2%) or bowel injury (1% vs 0%). There were more complications in the low-volume group vs the high-volume group when looking at complications aside from urinary tract, bowel, or major vessel injury.

Research perspectives

To our knowledge, this was the first study to look at differences in urinary tract injury rates in general gynecologists vs subspecialists. This study provides a guide for further and more widespread studies to be performed to investigate if a difference truly exists.