PREDICTING RISK OF COMPLICATIONS WITH GYNECOLOGIC LAPAROSCOPIC SURGERY

Objective: To determine the incidence and predictors of risk for opera tive complications, conversions to laparotomy, and postoperative admis sions after laparoscopic procedures. Methods: We obtained demographic information on and medical histories of a consecutive series of 843 wo men who underwent laparoscopic surgery for all procedures other than t ubal ligation at Brigham and Women's Hospital during 1994. All major c omplications after surgery were recorded. Major operative complication s were defined as bowel, bladder, meter, or vascular injuries or signi ficant abdominal wall or other internal bleeding. Categorical analysis was used to compare differences in the rates of operative complicatio ns, conversions to laparotomy, and postoperative admissions after lapa roscopy. We also estimated the influence of medical history and specif ic laparoscopic procedures on the risk of adverse complications after surgery. Results: Operative complications and conversion to laparotomy occurred in 1.9% and 4.7% of laparoscopic procedures, respectively. C omplications included four bowel, two bladder, one ureteral, two vascu lar, and five abdominal wall injuries. There were 165 patients (19.6%) admitted postoperatively. Aside from the type of operative procedure, increasing age was the most important predictor of complications. Rel ative to all other operative procedures, women treated for endometrios is or ovarian cystectomy had generally low rates of operative complica tions, conversions to laparotomy, and postoperative admissions. In con trast, 12.5% of women undergoing laparoscopically assisted vaginal hys terectomy experienced operative injuries or abdominal bleeding and 90% were hospitalized postoperatively. Conclusion: Serious operative comp lications after gynecologic laparoscopy were rare in this patient popu lation. The more complex laparoscopic procedures resulted in proportio nately greater rates of operative complications, conversions to laparo tomy, and postoperative admissions to the hospital. (Obstet Gynecol 19 98;92:327-31. (C) 1998 by The American College of Obstetricians and Gy necologists.).