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

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