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

## TL;DR

This study compares outcomes after two surgeries and finds that hysterectomy leads to more opioid and antibiotic use and higher risk of opioid dependence compared to sacrocolpopexy.

## Contribution

The study provides new comparative evidence on postoperative opioid and antimicrobial use risks between abdominal hysterectomy and sacrocolpopexy using global federated health data.

## Key findings

- Hysterectomy patients had significantly higher antimicrobial use compared to sacrocolpopexy patients.
- Opioid use and abuse/dependence were more frequent after hysterectomy than after sacrocolpopexy.
- No significant difference in antimicrobial resistance or paralytic ileus was observed between the two procedures.

## Abstract

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

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.

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.

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.

•Greater risk of postoperative antimicrobial use with abdominal hysterectomy.•Abdominal hysterectomy is associated with greater risk of postoperative opioid use.•Higher risk of opioid dependence/abuse with abdominal hysterectomy.

Greater risk of postoperative antimicrobial use with abdominal hysterectomy.

Abdominal hysterectomy is associated with greater risk of postoperative opioid use.

Higher risk of opioid dependence/abuse with abdominal hysterectomy.