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Combining hysterectomy with reconstructive surgery increases complications

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Women who undergo vaginal hysterectomy and reconstructive pelvic surgery during the same operation are more likely to have perioperative complications than those who undergo hysterectomy alone, new research shows.

Until now, “no studies have compared complication rates in women undergoing vaginal hysterectomy with those having vaginal hysterectomy with reconstructive pelvic surgery,” Dr. John B. Gebhart and co-researchers, from the Mayo Clinic, Rochester, Minnesota, point out.

Their study, reported in the October issue of Obstetrics and Gynecology, included 736 women who underwent vaginal hysterectomy for a benign condition. The primary endpoint was any complication, as indicated by intensive care unit admission, readmission, reoperation, or medical intervention within 9 weeks of surgery.

Complete follow-up data was available for 712 patients, including 336 who underwent hysterectomy plus reconstruction and 376 who underwent hysterectomy only, the report indicates.

Significantly more women in the combined surgery group had complications compared to women in the hysterectomy-only group: 43.8% vs. 20.5% (p < 0.001).

The authors point out that women in the group with concomitant reconstruction “were older and had a higher stage of prolapse.” Even after adjusting for age, surgical indication, and change in hemoglobin, combined surgery was associated with a threefold increased risk of complications.

Specific complications that were more common in the combined surgery group included urinary tract infection, pulmonary edema, and unplanned ICU admission. Urinary tract infection was a key contributor to the higher rate seen in combined surgery group, but even after excluding it, the complication rate was still higher in this group: 22.9% vs. 16.5% (p = 0.03).

“Quantifying perioperative and postoperative morbidity in women undergoing vaginal hysterectomy with additional reconstructive pelvic surgery allows identification of higher-risk patients,” the authors state.

Obstet Gynecol 2009;114:720-726.