Factors associated with complications of vaginal hysterectomy in patients with pelvic organ prolapse — a single centre’s experience
Abstract
Objectives: The study aimed to examine the predisposing factors that play a role in the development of complications in patients undergoing vaginal hysterectomy. Material and methods: This retrospective analysis was performed on data provided from 239 patients who underwent vaginal hysterectomy due to uterine prolapse at a single centre between January 2008 and August 2018. Complications were defined according to Clavien-Dindo classification of complications. The patients were divided into two groups: with and without complications. We built a model using multivariable logistic regression to examine the relationships between complications and five candidate predictors. Results: Intra/postoperative complications developed in 30 patients, and the complication rate was found to be 12.5%. 87.2% of the reported complications were classified as Grade ≤ 2 according to Clavien-Dindo system. It was found that complications were associated with factors such as intraoperative concurrent salpingo-oophorectomy [Odds ratio (OR): 1.24 (1.1–1.4)], low preoperative haemoglobin [OR: 0.96 (0.94–0.98)], uterine weight [OR: 2.69 (2.62–2.76)], and long operation time [OR: 1.04 (1.02–1.07)]. History of pelvic surgery was not found to increase complication rate [OR: 1.11 (0.96–1.27), p = 0.13]. Our multiple logistic regression model correctly classified 74% of participants within the Receiver Operating Characteristic (ROC) curve. Conclusions: Preoperative anaemia, large uterus and concomitant adnexectomy were found to be factors associated with complications during and after vaginal hysterectomy for pelvic organ prolapse.
Keywords: vaginal hysterectomyperioperative complicationspredisposing factorsconcurrent salpingo-oophorectomyuterine weightoperation time
References
- Wright JD, Herzog TJ, Tsui J, et al. Nationwide trends in the performance of inpatient hysterectomy in the United States. Obstet Gynecol. 2013; 122(2 Pt 1): 233–241.
- Aarts JWM, Nieboer TE, Johnson N, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2015(8): CD003677.
- Gupta J. Vaginal hysterectomy is the best minimal access method for hysterectomy. Evid Based Med. 2015; 20(6): 210.
- Boyles SH, Weber AM, Meyn L. Procedures for pelvic organ prolapse in the United States, 1979-1997. Am J Obstet Gynecol. 2003; 188(1): 108–115.
- Yassa M, Tug N. Uterus-preserving Laparoscopic Lateral Suspension with Mesh Operation in Pelvic Organ Prolapse: Initial Experience in a Single Tertiary Center with a Median 24-Month Follow-up. Geburtshilfe Frauenheilkd. 2019; 79(9): 983–992.
- Pandey D, Sehgal K, Saxena A, et al. An audit of indications, complications, and justification of hysterectomies at a teaching hospital in India. Int J Reprod Med. 2014; 2014: 279273.
- Louie M, Strassle PD, Moulder JK, et al. Uterine weight and complications after abdominal, laparoscopic, and vaginal hysterectomy. Am J Obstet Gynecol. 2018; 219(5): 480.e1–480.e8.
- Dessources K, Hou JY, Tergas AI, et al. Factors associated with 30-day hospital readmission after hysterectomy. Obstet Gynecol. 2015; 125(2): 461–470.
- Karacan T, Ozyurek E, Wetherilt LS, et al. Safety and efficacy of using advanced electrosurgical bipolar vessel sealing during vaginal hysterectomy in morbidly obese patients: a retrospective cohort analysis. Ginekol Pol. 2017; 88(10): 523–529.
- Akyol D, Esinler I, Guven S, et al. Vaginal hysterectomy: results and complications of 886 patients. J Obstet Gynaecol. 2006; 26(8): 777–781.
- Persu C, Chapple CR, Cauni V, et al. Pelvic Organ Prolapse Quantification System (POP-Q) - a new era in pelvic prolapse staging. J Med Life. 2011; 4(1): 75–81.
- Dindo D. The Clavien–Dindo Classification of Surgical Complications. Treatment of Postoperative Complications After Digestive Surgery. 2013: 13–17.
- CW Z. Vaginal hysterectomy. TeLinde’s Oper Gynecol 11 n.d.:P715.
- Jeppson PC, Balgobin S, Rahn DD, et al. Society of Gynecologic Surgeons Systematic Review Group. Comparison of Vaginal Hysterectomy Techniques and Interventions for Benign Indications: A Systematic Review. Obstet Gynecol. 2017; 129(5): 877–886.
- Sewell T, Courtney H, Tawfeek S, et al. The feasibility and safety of transvaginal bilateral salpingo-oophorectomy. Int J Gynaecol Obstet. 2018; 141(3): 344–348.
- Antosh DD, High R, Brown HW, et al. Feasibility of prophylactic salpingectomy during vaginal hysterectomy. Am J Obstet Gynecol. 2017; 217(5): 605.e1–605.e5.
- Sirota I, Tomita S, Dabney L, et al. Overcoming barriers to vaginal hysterectomy: an analysis of perioperative outcomes. J Turk Ger Gynecol Assoc. 2018.
- Newbold P, Vithayathil M, Fatania K, et al. Is vaginal hysterectomy is equally safe for the enlarged and normally sized non-prolapse uterus? A cohort study assessing outcomes. Eur J Obstet Gynecol Reprod Biol. 2015; 185: 74–77.
- Schmitt JJ, Occhino JA, Weaver AL, et al. Outcomes of Vaginal Hysterectomy With and Without Perceived Contraindications to Vaginal Surgery. Female Pelvic Med Reconstr Surg. 2019; 25(1): 41–48.
- Agostini A, Bretelle F, Cravello L, et al. Vaginal hysterectomy in nulliparous women without prolapse: a prospective comparative study. BJOG. 2003; 110(5): 515–518.
- Chrysostomou A, Djokovic D, Edridge W, et al. Evidence-based guidelines for vaginal hysterectomy of the International Society for Gynecologic Endoscopy (ISGE). Eur J Obstet Gynecol Reprod Biol. 2018; 231: 262–267.
- Turgut A, Soydinç HE, Evsen MS, et al. Which parameters may influence the duration of hospitalization after vaginal hysterectomy? J Turk Ger Gynecol Assoc. 2013; 14(1): 15–18.
- Ottosen C, Lingman G, Ottosen L. Three methods for hysterectomy: a randomised, prospective study of short term outcome. BJOG. 2000; 107(11): 1380–1385.
- Mehta A, Xu T, Hutfless S, et al. Patient, surgeon, and hospital disparities associated with benign hysterectomy approach and perioperative complications. Am J Obstet Gynecol. 2017; 216(5): 497.e1–497.e10.