Abstract

Background and Objective: The indications for computerized tomography (CT) scan to evaluate complications of minimally invasive surgery have not been well established. The objective of this study was to identify patient characteristics and clinical findings that correlated with postoperative complications diagnosed on CT scan after minimally invasive hysterectomy.

Methods: A retrospective cohort study of patients who underwent laparoscopic or robotic hysterectomy, from January 2011 to December 2013, was performed to determine the incidence of surgical complications within 30 days of surgery. The study compared patients who had a CT of the abdomen/pelvis to patients who did not have a CT scan. CT findings were defined as normal or abnormal with abnormal findings categorized as infectious, gastrointestinal injury, noninfectious fluid collections, and urinary injury.

Results: Seven hundred eighty-four patients underwent minimally invasive hysterectomy. Seventy-four (9.4%) had a CT scan. Patients who had a CT scan had a lower body mass index (BMI) (p=0.03) and were of younger age (p=0.05). Preoperative conditions of chronic pain (p=0.005) and history of prior abdominal surgery (p=0.002) were statistically associated with having a CT scan. Patients with endometriosis were statistically more likely to have a CT scan when compared to other benign diagnoses (p=0.001). No malignant diagnosis was associated with having a CT scan. In the CT group, analysis of CT findings showed a correlation between fever and infectious complications (p=0.006) and hemoglobin level and noninfectious fluid collections (p=0.04).

Conclusions: Clinical findings of fever and decreased hemoglobin were associated with abnormal CT results in patients who had minimally invasive hysterectomy. Patients with BMI< 30, history of chronic abdominal pain, history of abdominal surgery, or a postoperative diagnosis of endometriosis were more likely to undergo a CT scan but did not have an increased incidence of an abnormal CT finding.