Effect of additional reconstructive surgery on perioperative and postoperative morbidity in women undergoing vaginal hysterectomy

OBJECTIVE: To estimate the risk of perioperative and postoperative morbidity among women undergoing vaginal hysterectomy with and without reconstructive pelvic surgery. METHODS: We collected patient demographics, baseline medical status, perioperative and postoperative findings, and surgical procedures for women aged 18 years or older who had vaginal hysterectomy for a benign indication at Mayo Clinic, Rochester, Minnesota, between January 2004 and December 2005. The main outcome measure was any complication, defined by intensive care unit (ICU) admission, reoperation, readmission, or medical intervention within 9 weeks after surgery. RESULTS: Of 736 patients who met the study criteria, 712 had complete follow-up information. Overall, more women undergoing vaginal hysterectomy with reconstructive pelvic surgery had complications than did those without reconstructive pelvic surgery (147 of 336 [43.8%] compared with 77 of 376 [20.5%], odds ratio [OR] 3.0, 95% confidence interval [CI] 2.2-4.2, P<.001). This association was significant (OR 3.0, 95% CI 1.5-6.2, P=.003) even after adjusting for factors that were significantly different between groups (age, surgical indication, and change in hemoglobin). Specifically, urinary tract infection, pulmonary edema, and unplanned ICU admissions were more common among those undergoing reconstructive pelvic surgery. Disregarding urinary tract infections, the overall complication rate was still higher among the women with concomitant reconstructive pelvic surgery (22.9% compared with 16.5%, OR 1.5, 95% CI 1.04-2.2, P=.03). CONCLUSION: Women having vaginal hysterectomy with additional reconstructive pelvic surgery were more likely to have a perioperative complication than were women undergoing vaginal hysterectomy alone.