One-year cohort of abdominal, vaginal, and laparoscopic hysterectomies: complications and subjective outcomes.
BACKGROUND
In the past decade, changes in operative approaches to hysterectomy have resulted in needs to renew study of postoperative morbidity.


METHODS
This prospective observational study, performed in a university teaching hospital in Finland, was conducted to determine the overall number of complications and subjective outcomes after hysterectomy for benign conditions. The population studied during a 1-year period consisted of 687 women, who underwent 516 abdominal hysterectomies, 105 vaginal hysterectomies, and 66 laparoscopic hysterectomies. Complications arising within 1 year of operations were recorded, and subjective complaints and outcomes were assessed using two questionnaire-based evaluations, the first following a convalescence period of 4 to 6 weeks, the second after 1 year.


RESULTS
Intraoperative complications occurred in 16 patients (2.3%), in 9 patients in the abdominal hysterectomy group (1.7%), and in 4 (3.9%) and 3 patients (4.5%) in the vaginal and laparoscopic hysterectomy groups, respectively. During the hospital stay postoperative complications were found in 28.5% of patients, in the vaginal hysterectomy group (41.9%) more often than in the abdominal and laparoscopic hysterectomy groups (28.3% and 9.1%, respectively). Postoperative infection, including urinary infection, was the main problem, during both the stay in the hospital and the convalescence period at home. It was also the principal reason for readmission to the hospital. Despite an increase in incidence of subjective complaints, from 14.9% during the first evaluation to 37.0% during the second (p < 0.001), 95% of respondents remained satisfied with their operation after 1 year.


CONCLUSIONS
Vaginal hysterectomy was more often associated with some adverse event, mainly postoperative infection, than abdominal and laparoscopic hysterectomy. Subjective outcomes were not influenced by the type of hysterectomy. Most patients were satisfied with the operation on both short- and longterm followup.
Meltomaa
S S
SS
Department of Obstetrics and Gynecology, University of Turku, Finland.
Mäkinen
J I
JI
Taalikka
M O
MO
Helenius
H Y
HY
D000328:Adult; D005260:Female; D005831:Genital Diseases, Female / Q000601:surgery; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods; D007045:Hysterectomy, Vaginal / Q000009:adverse effects* / Q000379:methods; D007431:Intraoperative Complications; D010535:Laparoscopy; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome