Hysterectomy complications differ by approach

Compared with abdominal hysterectomy, vaginal and laparoscopy-assisted vaginal hysterectomies (LAVH) are associated with fewer complications during the initial hysterectomy admission but result in more readmissions thereafter, according to an Australian report in BJOG: An International Journal of Obstetrics and Gynaecology.

Previous studies have suggested that vaginal hysterectomy, with or without laparoscopy assistance, is associated with reduced morbidity outcomes compared with abdominal hysterectomy, the authors explain, but little is known about hysterectomy outcomes among Australian women.

Abdominal hysterectomy is the traditional procedure in which an incision is made in the lower abdominal and the uterus is removed. Vaginal hysterectomy involves removing the uterus through the vagina. With LAVH, several small incisions are made in the abdominal wall through which slender metal tubes known as "trocars" are inserted to allow passage of laparoscope and other microsurgical tools. The laparoscope is like a tiny telescope with a camera attached to it that provides a continuous, magnified image projected onto a television screen. The uterus is also removed through the vagina with this procedure.

Dr. Katrina Spilsbury from Curtin University of Technology, Perth, and colleagues evaluated morbidity outcomes following hysterectomy for benign reasons (not cancer) in all Western Australian hospitals from 1981 to 2003.

Procedure-related hemorrhage and postprocedural infections (excluding urinary tract infection) were less common with vaginal hysterectomy than with abdominal hysterectomy, the authors report.

Length of hospital stay was shortest for women who underwent LAVH (4 days), followed by vaginal procedures (6 days) and then abdominal hysterectomies (8 days).

Compared with abdominal hysterectomy, vaginal hysterectomy and LAVH increased the odds of being readmitted to hospital for postprocedural hemorrhage (43 percent and 45 percent, respectively) and increased the odds of readmission for postprocedural genitourinary complications (65 percent 66 percent), the researchers note.

Other factors associated with an increased risk of complications included younger age, increased number of other illnesses and undergoing surgery in a teaching hospital, the report indicates.

"These findings identify women at risk of readmission following hysterectomy and highlight an opportunity to modify early discharge and patient follow-up practices to reduce this risk," the investigators conclude.

BJOG: An International Journal of Obstetrics and Gynaecology, November 2008.

NEW YORK (Reuters Health)