Kroft J, McCaffrey C, Kim E, Jolliffe C, Liu GY, Saskin R, Gatley JM, Ordon M. Surgical Outcomes between Routes of Hysterectomy in Patients with a Previous Cesarean Section.
J Minim Invasive Gynecol 2023;
30:319-328.e9. [PMID:
36646311 DOI:
10.1016/j.jmig.2023.01.003]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 01/15/2023]
Abstract
STUDY OBJECTIVE
To determine the difference in surgical complications for patients with a previous cesarean section (CS) undergoing abdominal, vaginal, or laparoscopic hysterectomy.
DESIGN
A population-based retrospective cohort study.
SETTING
Province of Ontario, Canada.
PATIENTS
10 300 patients with at least 1 CS between July 1, 1991, and February 17, 2018.
INTERVENTIONS
Benign, nongravid hysterectomy between Apr 1, 2002, and March 31, 2018.
MEASUREMENTS AND MAIN RESULTS
The primary outcome was a composite of all surgical complications within 30 days of surgery. Secondary outcomes were rate of genitourinary complications, readmission to hospital, and emergency department visit occurring within 30 days of surgery. Of 10 300 patients who had at least one previous CS, who underwent subsequent hysterectomy for a benign indication, 7370 underwent an abdominal hysterectomy (71.55%), 813 (7.9%) had a vaginal hysterectomy, and 2117 (20.55%) underwent a laparoscopic hysterectomy. The adjusted odds of any surgical complication from hysterectomy was significantly lower when performed by the vaginal approach than the laparoscopic approach (odds ratio, 0.32; 95% confidence interval, 0.20-0.51; p <.0001). There was no difference in the odds of surgical complication between abdominal and laparoscopic approaches (odds ratio, 1.09; 95% confidence interval, 0.87-1.37; p = .45).
CONCLUSION
Our retrospective population-based study demonstrates that, after previous CS, patients selected to undergo vaginal hysterectomy experienced lower risk than either abdominal or laparoscopic approaches. This suggests that CS alone should not be a contraindication to vaginal hysterectomy.
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