Outcomes of Vaginal Hysterectomy With and Without Perceived Contraindications to Vaginal Surgery
| Autor: | Jennifer J. Schmitt, John A. Occhino, Amy L. Weaver, John B. Gebhart, Michaela E. McGree |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
medicine.medical_specialty Intraoperative Complication Urology medicine.medical_treatment Contraindications Procedure 03 medical and health sciences 0302 clinical medicine Postoperative Complications Hysterectomy Vaginal Medicine Humans 030212 general & internal medicine Obesity Intraoperative Complications Contraindication Retrospective Studies 030219 obstetrics & reproductive medicine Hysterectomy business.industry Obstetrics Cesarean Section Uterus Obstetrics and Gynecology Postoperative complication Retrospective cohort study Odds ratio Length of Stay Middle Aged Debulking Confidence interval Treatment Outcome Surgery Female business |
| Zdroj: | Female pelvic medicinereconstructive surgery. 25(1) |
| ISSN: | 2154-4212 |
| Popis: | Objective The aim of this study was to compare outcomes of vaginal hysterectomy between patients with and without the following perceived contraindications to vaginal surgery: uterine weight greater than 280 g, prior cesarean delivery, no vaginal parity, and obesity. Methods Retrospective cohort of benign vaginal hysterectomies between 2009 and 2013 was obtained. Outcomes included uterine debulking, transfusion, intraoperative complications, length of stay, and Accordion grade 2+ postoperative complications. For each outcome, the association between the presence of each contraindication and the outcome was evaluated using univariate and multivariate logistic regression models. Results Among 692 vaginal hysterectomies, 11% (76/691) had a uterine weight greater than 280 g, 11.3% (78/690) had no vaginal parity, 14.9% (103/690) had a history of cesarean delivery, and 37.7% (248/657) had a body mass index of 30 kg/m or greater; 110 (15.9%) had 2 or more contraindications. Uterine debulking occurred in 146 women (21.1%), and both uterine weight greater 280 g (adjusted odds ratio, 39.2; 95% confidence interval, 18.4-83.5) and prior cesarean delivery (adjusted odds ratio, 2.1; 95% confidence interval, 1.2-3.7) were significantly associated with an increased likelihood of uterine debulking after adjusting for age, hematologic disease, and preoperative diagnosis. None of the contraindications were significantly associated with need for a blood transfusion, presence of an intraoperative complication, length of stay greater than 2 days, or presence of an Accordion grade 2+ postoperative complication, which occurred in 2.7%, 2.5%, 14.0%, and 6.9% of all women, respectively. Conclusions Vaginal hysterectomy can be safely performed with favorable outcomes, even in women with a uterus greater than 280 g, prior cesarean delivery, no vaginal parity, and obesity. Our findings challenge several perceived contraindications to vaginal hysterectomy. |
| Databáze: | OpenAIRE |
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