| Popis: |
Study Objective To determine the difference in surgical complications for women with a prior cesarean section (CS) undergoing abdominal (AH), vaginal (VH) or laparoscopic (LH) hysterectomy. Design A population based retrospective cohort study. Setting Ontario, Canada. Patients or Participants This study included 71,599 women in Ontario, Canada with at least 1 delivery between July 1, 1991 and February 17, 2018 who subsequently underwent benign, non-gravid hysterectomy between April 1, 2002 and March 31, 2018. Interventions At least one CS delivery. Measurements and Main Results Of the 71,599 patients who met the study criteria, 10,300 (14.3%) had at least one previous CS. Among women with no previous CS, the incidence of AH, VH and LH was 53.6%, 24.1% and 22.3% respectively. For women with a previous CS, the respective incidences of hysterectomy were 71.6%, 7.9% and 20.6%. Compared with women who had only vaginal deliveries, multivariable analysis showed that previous CS significantly increased the odds of the primary outcome, any surgical complication 30 days from hysterectomy (OR=2.2 95% CI 2.02-2.4, p Conclusion This study demonstrates that a history of CS increases the risk of any surgical complication from a subsequent hysterectomy regardless of surgical approach. Contrary to traditional teaching, acknowledging the limitations of this retrospective study, it also suggests that VH may be associated with less risk than either abdominal or laparoscopic approaches even in the setting of a previous CS. |
