Pelvic organ prolapse surgery following hysterectomy on benign indications.
OBJECTIVE
The objective of the study was to determine the risk for pelvic organ prolapse surgery attributed to hysterectomy on benign indications


METHODS
In a nationwide longitudinal study, 162,488 women with hysterectomy from 1973 through 2003 were matched to 470,519 population-based control women. Hazard ratios (HR) with 95% confidence interval (CI) were calculated using Cox regression analyses.


RESULTS
In all, 3.2% (n = 5270) of women with hysterectomy had pelvic organ prolapse surgery, compared with 2.0% (n = 9437) in nonhysterectomized controls. Compared with nonhysterectomized controls, the overall HR for prolapse surgery was 1.7 (95% CI, 1.6 to 1.7) with the highest risks observed in women having had a vaginal hysterectomy (HR 3.8; 95% CI, 3.1 to 4.8). Compared with hysterectomized women with no vaginal births, the HR for prolapse surgery was 2.0 (95% CI, 0.9 to 4.1) among women with 1 vaginal childbirth and 11.3 (95 % CI, 6.0. to 21.1) among women with at least 4 vaginal births.


CONCLUSIONS
Hysterectomy is associated with an increased risk for subsequent pelvic organ prolapse surgery with multiparous women at particular risk.
Altman
Daniel
D
Department of Medical Epidemiology and Biostatistics, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden. daniel.altman@ki.se
Falconer
Christian
C
Cnattingius
Sven
S
Granath
Fredrik
F
D000328:Adult; D015987:Effect Modifier, Epidemiologic; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D010298:Parity; D011183:Postoperative Complications / Q000453:epidemiology; D011247:Pregnancy; D012042:Registries; D012044:Regression Analysis; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D014596:Uterine Prolapse / Q000453:epidemiology*