Comparative analysis of postoperative outcomes following hysterectomy versus sacrocolpopexy: Insights from global federated health research network.

OBJECTIVE

To compare the risk of opioid use, antimicrobial utilization, and postoperative complications, including paralytic ileus, between patients undergoing abdominal hysterectomy and sacrocolpopexy.

METHODS

Using a global federated health research network, we performed a retrospective cohort analysis. After 1:1 propensity score matching for age, BMI, race, ethnicity, diabetes, and hypertension, 993 patients were included per group. Kaplan-Meier survival analysis assessed antimicrobial and opioid use, resistance, and opioid abuse or dependence.

RESULTS

Mean follow-up was significantly longer in the sacrocolpopexy group (7.67 ± 4.66 years) than in the hysterectomy group (3.13 ± 4.23 years). Hysterectomy patients experienced a higher mean number of postoperative complications although these results were not statistically significant (p = 0.0688). Postoperative antimicrobial use was significantly higher in the hysterectomy group (25.9 %) than sacrocolpopexy (14.1 %) (HR 3.84, 95 % CI: 2.99-4.93; p < 0.0001). Opioid use was also more frequent in hysterectomy patients (44.4 % vs. 15.6 %; HR 5.68, 95 % CI: 4.69-6.88; p < 0.0001), with a higher incidence of abuse/dependence (6.04 % vs. 2.02 %; HR 6.91, 95 % CI: 4.07-11.73). No significant difference was observed in antimicrobial resistance (p = 0.4409). Paralytic ileus was rare and not significantly different between groups.

CONCLUSION

Hysterectomy was associated with greater risk of postoperative opioid use, opioid abuse/dependence, and antimicrobial use. These findings support individualized surgical planning and proactive postoperative management.