Prognostic factors for morcellation during vaginal hysterectomy

Megan Wasson, Kristina Butler, Paul Magtibay, M'hamed Temkit, Javier Magrina

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

OBJECTIVE: To determine prognostic factors associated with cold-knife morcellation during vaginal hysterectomy. METHODS: We conducted a retrospective cohort study evaluating all consecutive patients undergoing a vaginal hysterectomy between January 1, 2009, and August 31, 2014. The primary outcome was the utilization of uncontained vaginal morcellation performed using cold-knife wedge resection at the time of vaginal hysterectomy. Secondary outcomes included perioperative data. Significant factors were included in a multivariate logistic regression model to the binary variable vaginal morcellation at the time of vaginal hysterectomy. RESULTS: A total of 743 women met study inclusion criteria and underwent vaginal hysterectomy with intact uterine removal (n383) or with uterine morcellation (n360) with and without other vaginal procedures. A nonparametric Wilcoxon-rank-sum test and χ 2 test were used to compare the cohorts of patients with and without morcellation. Characteristics associated with significantly increased likelihood of morcellation included younger age, non-Caucasian race, American Society of Anesthesiologists class 1 or 2, lower parity, lower number of prior vaginal deliveries, absence of prolapse, presence of leiomyoma, and an enlarged uterus. A multivariate logistic model utilizing factors most likely associated with morcellation revealed lack of prolapse (adjusted odds ratio [OR] 3.87, P<.001), leiomyoma (adjusted OR 2.77, P.035), and larger uterine weight (adjusted OR 7.25, P<.001) increased the likelihood of morcellation. Prior vaginal delivery was associated with a decreased likelihood of morcellation (adjusted OR 0.79, P.005). CONCLUSION: Vaginal hysterectomy with morcellation is associated with the following factors: absence of prior vaginal delivery, absence of prolapse, presence of leiomyoma, and a uterus larger than normal size.

Original languageEnglish (US)
Pages (from-to)752-757
Number of pages6
JournalObstetrics and gynecology
Volume127
Issue number4
DOIs
StatePublished - Apr 1 2016

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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