Objective: The objective of the study was to develop a clinically applicable prediction tool to early seek for postoperative major complications after laparoscopic surgery for benign pathologies. Design: Retrospective analysis of prospectively collected data was performed. Setting: The study was conducted at Tertiary Care University Hospital. Participants: The participants of this study were reproductive-aged women undergoing laparoscopy for benign conditions. Methods: Anamnestic, intraoperative, and postoperative characteristics from January 2019 to December 2021 were retrospectively reviewed. Patients with postoperative complications (reintervention or postoperative bleeding) were matched in a 1:2 ratio with women with same surgical indications without complications. Cases and controls were matched for preoperative hemoglobin, hematocrit, weight, height, body mass index, age, and blood volume. A prediction model was created by inserting multiple independent modifying factors through logistic regression. The receiver operating characteristic (ROC) curve was used to evaluate the predictive accuracy of the model, and the Hosmer-Lemeshow (H-L) test was carried out to evaluate the goodness-of-fit, and a calibration curve was drawn to confirm the predictive performance. A nomogram was depicted to visualize the prediction model. Results: Thirty-nine complicated procedures were matched with 78 uncomplicated controls. According to the multivariate logistic regression analysis findings, the prediction model was developed using C-reactive protein (CRP), intraoperative blood loss, and 24 h postoperative urinary volume, therefore a nomogram was generated. The area under the ROC curve of the prediction model was 0.879, depicting good accuracy, the sensitivity was 60.00%, while specificity reached 93.59%. The H-L test (χ2 = 4.45, p = 0.931) and the calibration curve indicated a good goodness-of-fit and prediction stability. Limitations: The retrospective design, moderate sensitivity, and study population limit the generalization of the findings, requiring additional research. Conclusions: This prediction model based on CRP, intraoperative blood loss, and 24 h postoperative urinary volume might be a potentially useful tool for predicting reintervention and postoperative bleeding in patients undergoing planned gynecological laparoscopy.

1.
Cho
JE
,
Shamshirsaz
AH
,
Nezhat
C
,
Nezhat
C
,
Nezhat
F
.
New technologies for reproductive medicine: laparoscopy, endoscopy, robotic surgery and gynecology. A review of the literature
.
Minerva Ginecol
.
2010
;
62
(
2
):
137
67
.
2.
Raffone
A
,
Raimondo
D
,
Oliviero
A
,
Raspollini
A
,
Travaglino
A
,
Torella
M
.
The use of near infra-red radiation imaging after injection of indocyanine green (NIR-ICG) during laparoscopic treatment of benign gynecologic conditions: towards minimalized surgery. A systematic review of literature
.
Medicina
.
2022
;
58
(
6
):
792
.
3.
Higgins
C
,
McDonald
R
,
Mol
BW
.
Indications and surgical route for hysterectomy for benign disorders: a retrospective analysis in a large Australian tertiary hospital network
.
Arch Gynecol Obstet
.
2022
;
306
(
6
):
2027
33
.
4.
Shim
SH
,
Suh
JH
,
Park
JE
,
Lee
SJ
,
Lee
JY
,
Kim
SN
.
Predictors of 30-day morbidity after hysterectomy for benign disease
.
Int J Gynaecol Obstet
.
2019
;
144
(
3
):
302
8
.
5.
Erekson
EA
,
Yip
SO
,
Martin
DK
,
Ciarleglio
MM
,
Connell
KA
,
Fried
TR
.
Major postoperative complications after benign gynecologic surgery: a clinical prediction tool
.
Female Pelvic Med Reconstr Surg
.
2012
;
18
(
5
):
274
80
.
6.
Capozzi
VA
,
Riemma
G
,
Rosati
A
,
Vargiu
V
,
Granese
R
,
Ercoli
A
.
Surgical complications occurring during minimally invasive sentinel lymph node detection in endometrial cancer patients. A systematic review of the literature and metanalysis
.
Eur J Surg Oncol
.
2021
;
47
(
8
):
2142
9
.
7.
Traven
SA
,
Reeves
RA
,
Slone
HS
,
Walton
ZJ
.
Frailty predicts medical complications, length of stay, readmission, and mortality in revision hip and knee arthroplasty
.
J Arthroplasty
.
2019
;
34
(
7
):
1412
6
.
8.
Vu
MM
,
Ellis
MF
,
Blough
JT
,
Gutowski
KA
,
Kim
JYS
.
Development and internal validation of the abdominoplasty risk calculator
.
Plast Reconstr Surg
.
2018
141
1
34e
45e
.
9.
Driessen
SR
,
Sandberg
EM
,
la Chapelle
CF
,
Twijnstra
AR
,
Rhemrev
JP
,
Jansen
FW
.
Case-mix variables and predictors for outcomes of laparoscopic hysterectomy: a systematic review
.
J Minim Invasive Gynecol
.
2016
;
23
(
3
):
317
30
.
10.
Hong
CX
,
Kamdar
NS
,
Morgan
DM
.
Predictors of same-day discharge following benign minimally invasive hysterectomy
.
Am J Obstet Gynecol
.
2022
227
2
320 e1
9
.
11.
Wechter
ME
,
Mohd
J
,
Magrina
JF
,
Cornella
JL
,
Magtibay
PM
,
Wilson
JR
.
Complications in robotic-assisted gynecologic surgery according to case type: a 6-year retrospective cohort study using Clavien-Dindo classification
.
J Minim Invasive Gynecol
.
2014
;
21
(
5
):
844
50
.
12.
Sears
S
,
Mangel
J
,
Adedayo
P
,
Mims
J
,
Sundaresh
S
,
Sheyn
D
.
Utility of preoperative laboratory evaluation in low-risk patients undergoing hysterectomy for benign indications
.
Eur J Obstet Gynecol Reprod Biol
.
2020
;
248
:
144
9
.
13.
Weinberg
L
,
Rao
S
,
Escobar
PF
.
Robotic surgery in gynecology: an updated systematic review
.
Obstet Gynecol Int
.
2011
;
2011
:
852061
.
14.
Nadler
SB
,
Hidalgo
JH
,
Bloch
T
.
Prediction of blood volume in normal human adults
.
Surgery
.
1962
;
51
(
2
):
224
32
.
15.
Ross
SW
,
Christmas
AB
,
Fischer
PE
,
Holway
H
,
Seymour
R
,
Huntington
CR
.
Defining dogma: quantifying crystalloid hemodilution in a prospective randomized control trial with blood donation as a model for hemorrhage
.
J Am Coll Surg
.
2018
;
227
(
3
):
321
31
.
16.
Delli Carpini
G
,
Morini
S
,
Tsiroglou
D
,
Verdecchia
V
,
Montanari
M
,
Donati
V
.
Factors influencing intraoperative blood loss and hemoglobin drop during laparoscopic myomectomy: a tailored approach is possible
.
J Obstet Gynaecol
.
2022
;
42
(
5
):
1404
9
.
17.
Klebanoff
JS
,
Marfori
CQ
,
Sparks
AD
,
Barnes
WA
,
Ingraham
CF
,
Moawad
GN
.
A clinically applicable prediction model for the risk of transfusion in women undergoing myomectomy
.
J Minim Invasive Gynecol
.
2021
;
28
(
10
):
1765
73.e1
.
18.
Pepin
K
,
Cook
F
,
Maghsoudlou
P
,
Cohen
SL
.
Risk-prediction model for patients undergoing laparoscopic hysterectomy
.
J Minim Invasive Gynecol
.
2021
;
28
(
10
):
1751
8.e1
.
19.
El Sabeh
M
,
Borahay
MA
.
The future of uterine fibroid management: a more preventive and personalized paradigm
.
Reprod Sci
.
2021
;
28
(
11
):
3285
8
.
20.
Cosma
S
,
Benedetto
C
.
Classification algorithm of patients with endometriosis: proposal for tailored management
.
Adv Clin Exp Med
.
2020
;
29
(
5
):
615
22
.
21.
Danelich
IM
,
Bergquist
JR
,
Bergquist
WJ
,
Osborn
JL
,
Wright
SS
,
Tefft
BJ
.
Early diuresis after colon and rectal surgery does not reduce length of hospital stay: results of a randomized trial
.
Dis Colon Rectum
.
2018
;
61
(
10
):
1187
95
.
22.
Srinivasa
S
,
Tan
ST
.
Postoperative fluid management in major elective plastic surgery
.
J Plast Reconstr Aesthet Surg
.
2010
;
63
(
6
):
992
5
.
23.
Myles
PS
,
Bellomo
R
,
Corcoran
T
,
Forbes
A
,
Peyton
P
,
Story
D
.
Restrictive versus liberal fluid therapy for major abdominal surgery
.
N Engl J Med
.
2018
;
378
(
24
):
2263
74
.
24.
Cosse
C
,
Regimbeau
JM
,
Fuks
D
,
Mauvais
F
,
Scotte
M
.
Serum procalcitonin for predicting the failure of conservative management and the need for bowel resection in patients with small bowel obstruction
.
J Am Coll Surg
.
2013
;
216
(
5
):
997
1004
.
25.
Shiota
M
,
Kotani
Y
,
Umemoto
M
,
Tobiume
T
,
Hoshiai
H
.
Incidence of complications in patients with benign gynecological diseases by BMI and level of complexity of laparoscopic surgery
.
Asian J Endosc Surg
.
2012
;
5
(
1
):
17
20
.
You do not currently have access to this content.