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An easy-to-use tool predicts problems in individuals following benign hysterectomy

Online prediction tools that give tailored risk estimations for individuals having a hysterectomy for benign illness have been created by researchers. The study that describes the models has been published in CMAJ (Canadian Medical Association Journal). One-third of women in Canada get a hysterectomy before the age of 60, making it one of the most prevalent surgical operations. Laparoscopic hysterectomies are becoming increasingly common because they are less intrusive than abdominal surgery. Currently, surgeons share the advantages of the operation as well as the dangers of problems with patients.

Researchers from the United Kingdom and Spain created and tested prediction algorithms with the goal of complementing a surgeon's professional judgment regarding which patients could be at risk of hysterectomy complications. Hysterectomies can result in ureteric, gastric, and vascular injuries, as well as wound complications. Between 2011 and 2018, the authors used data from the English National Health Service (NHS) on 68 599 women who underwent laparoscopic hysterectomies and 125 971 women who had abdominal hysterectomies.

According to Dr. Krupa Madhvani of the Queen Mary University of London in the United Kingdom, a surgeon's gut instinct has traditionally been proved to be a good predictor of postoperative results. In evidence-based medicine, however, an expert opinion has the lowest value. Although a surgeon's knowledge and professional advice are valuable, they should not be relied on alone to advise risk management. In Canada and across the world, the overall incidence of hysterectomy for benign illnesses is decreasing, and more patients are being operated on by lower-volume surgeons who may not be experts in all procedures.

The researchers included 11 predictors, such as age, BMI, and diabetes, and also added ethnicity as a possible risk factor, classifying patients' self-described ethnicity based on a recent census.

The authors state, ethnicity has been shown to be an independent factor influencing the route and complications of hysterectomy.

They discovered that Asian women had a greater risk of significant complications following abdominal hysterectomy than white women, however, the risk was not connected with laparoscopy. The presence of adhesions was the most important risk factor for serious problems in both operations, which is consistent with current research.

The authors concluded that these tools will guide shared decision-making and may lead to a referral to centers with greater surgical expertise or to the exploration of nonsurgical treatment options.

Journal Information: Predicting major complications in patients undergoing laparoscopic and open hysterectomy for benign indications, Canadian Medical Association Journal (2022). DOI: 10.1503/cmaj.220914
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