title: Risk factors for pelvic floor repair after hysterectomy.
abstract: OBJECTIVE
  Having demonstrated that prior history of prolapse was a risk factor for pelvic floor repair procedures after hysterectomy, the objective of this study was to assess medical risk factors for pelvic floor repair after hysterectomy.
  
  
  METHODS
  Using the Rochester Epidemiology Project database of 8,220 Olmsted County, Minnesota, women who had hysterectomy for benign indications from 1965-2002, we conducted a nested case-control study in 144 pairs, comparing women who underwent pelvic floor repair after hysterectomy (case group) with women matched for known risk factors (ie, age, pelvic floor disorders at baseline, year and type of hysterectomy, and pelvic floor repair during hysterectomy) (control group).
  
  
  RESULTS
  The median duration between hysterectomy and pelvic floor repair was 13 years. Chronic pulmonary disease (odds ratio [OR] 14.3, 95% confidence interval [CI] 1.2-178), but not obstetric history, obesity, indication for hysterectomy, or chronic constipation, was associated with an increased risk of pelvic floor repair after hysterectomy. Between the hysterectomy and subsequent pelvic floor repair, overall pelvic organ prolapse severity changed by one grade or less in 54 case patients (38%, group A) but increased by two or more grades in 72 case patients (50%, group B). In group A, but not group B, uterine prolapse (OR 25, 95% CI 2.1-300) and chronic pulmonary disease (OR 22, 95% CI 1.5-328) at baseline remained risk factors for pelvic floor repair after hysterectomy.
  
  
  CONCLUSIONS
  In this matched case-control study, chronic pulmonary disease was the only risk factor for pelvic floor repair after hysterectomy for benign indications, underscoring the need to address pulmonary status before surgery.
authors.affiliation: From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, the Division of Gastroenterology and Hepatology, Department of Internal Medicine, and the Divisions of Epidemiology and Biostatistics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Roberta E
authors.initials: RE
authors.lastname: Blandon
authors.forename: Adil E
authors.initials: AE
authors.lastname: Bharucha
authors.forename: L Joseph
authors.initials: LJ
authors.lastname: Melton
authors.forename: Cathy D
authors.initials: CD
authors.lastname: Schleck
authors.forename: Alan R
authors.initials: AR
authors.lastname: Zinsmeister
authors.forename: John B
authors.initials: JB
authors.lastname: Gebhart
mesh_terms: D016022:Case-Control Studies; D052858:Cystocele / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007889:Leiomyoma / Q000601:surgery; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D017773:Pelvic Floor / Q000601:surgery; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology*; D020047:Rectocele / Q000601:surgery; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014594:Uterine Neoplasms / Q000601:surgery; D014596:Uterine Prolapse / Q000453:epidemiology* / Q000601:surgery