Perioperative Outcomes of Total Vaginal Hysterectomy in Women with Prior Cesarean Delivery

Study Objective: To compare the incidence of perioperative complications of total vaginal hysterectomy (TVH) in women with and without a prior cesarean section (CS). Design: Retrospective cohort. Setting: Tertiary care academic institution. Patients: A total of 742 women who underwent TVH over a 5-year period. Interventions: TVH. Measurements and Main Results: Prior CS did not increase the overall rate of Clavien-Dindo grades 2 to 3 complications (p =.20). The incidence of cystotomy (2.2% CS vs 1.1% no CS, p =.29), ureteral injury (1.1% vs 0.2%, p =.23), proctotomy (1.1% vs 0.2%, p =.23), postoperative bleeding (1.1% vs 0.6%, p =.47), or reoperation (0.0% vs 0.3%, p = 1.00) was not increased from having a prior CS. Prior CS increased blood transfusion (5.6% vs 0.6%, p <.05) but did not increase conversion to laparotomy (2.2% vs 0.6%, p =.15), length of hospitalization (11.2% vs 14.1% discharge on the same day, 66.3% vs 63.6% discharge on postoperative day 1, and 22.5% vs 22.4% discharge on or after postoperative day 2, p =.76), or 30-day readmission rates (1.1% vs 3.5%, p =.34). Conclusion: In patients who underwent TVH, a prior CS increased postoperative blood transfusion but did not increase the risk for overall perioperative complications.