XXXX : a shared clinical decision tool for mode of hysterectomy.

@entity1 @entity242 @entity5 @entity190 @entity1661 @entity281 @entity547 @entity2909 @entity1211 @entity1744
OBJECTIVE: To compare risks and benefits of laparoscopic hysterectomy with morcellation versus abdominal hysterectomy without morcellation for large fibroids. STUDY DESIGN: We developed a shared clinical decision tool to communicate risks and benefits of laparoscopic versus abdominal hysterectomy to @entity1 with large fibroids as mandated by the FDA. The decision tool was designed to serve as a framework for providers to counsel @entity1 about mode of hysterectomy to facilitate shared decision-making between @entity1 and provider. Risks and benefits were estimated from the literature, including surgical complications ( @entity1211 , @entity1744 , adhesions, @entity281 , and transfusions), uterine @entity242 risks, and quality-of-life endpoints. The shared clinical decision tool was applied to a hypothetical population of 20,000 @entity1 with large uterine fibroids, of which 10,000 underwent laparoscopic hysterectomies and 10,000 had abdominal hysterectomies. RESULTS: @entity1661 would result in 50.1% more adhesions, 10.7% more @entity547 , 4.8% more surgical site infections, 2.8% more @entity1744 , and 2% more @entity1211 compared to laparoscopic hysterectomy. @entity1661 would also result in longer hospital stays (2 days), slower return to work (13.6 days), greater postoperative day 3 narcotic requirements (48%), and lower SF-36 quality-of-life scores (50.4 points lower). 0.28% of @entity2909 @entity1 would have unsuspected uterine @entity242 . Among these @entity1 , laparoscopic hysterectomy with morcellation would have a 27% reduction in 5-year overall survival rates and a 28.8 month shorter recurrence-free survival period. CONCLUSION: Some evidence suggests laparoscopic hysterectomy with morcellation may result in increased risk of @entity5 with worse survival outcomes among uterine @entity242 @entity1 compared to abdominal hysterectomy without morcellation, however, the current data is limited and the exact risks associated specifically with electromechanical morcellation are not conclusive. Data also supports abdominal hysterectomy would lead to a net detriment in other outcomes, with greater risks of @entity1211 , obstruction, @entity547 , adhesions, @entity281 , and @entity190 compared to laparoscopic hysterectomy. This shared clinical decision tool may aid the @entity1 and physician in determining an optimal mode of hysterectomy for large uterine fibroids while taking account of risks and benefits as mandated by the FDA.
