Morbidity and mortality of peripartum hysterectomy.
OBJECTIVE
To perform a population-based analysis to examine the morbidity and mortality of peripartum hysterectomy in comparison with nonobstetric hysterectomy.


METHODS
Data from the Nationwide Inpatient Sample were used to compare peripartum and nonobstetric hysterectomy in women younger than 50 years of age. Intraoperative, perioperative, and postoperative medical complications were examined. The outcomes of peripartum and nonobstetric hysterectomy were compared using chi square. Odds ratios were calculated using multivariable logistic regression models for each individual complication.


RESULTS
A total of 4,967 women who underwent peripartum hysterectomy and 578,179 patients who had a nonobstetric hysterectomy were identified. Bladder (9% compared with 1%) and ureteral (0.7% compared with 0.1%) injuries were more common for peripartum hysterectomy (P<.001). There were no differences in the rates of intestinal or vascular injuries between peripartum and nonobstetric hysterectomy. Rates of reoperation (4% compared with 0.5%), postoperative hemorrhage (5% compared with 2%), wound complications (10% compared with 3%), and venous thromboembolism (1% compared with 0.7%) were all higher in women who underwent peripartum hysterectomy. In multivariable analysis, the odds ratio for death for peripartum compared to nonobstetric hysterectomy was 14.4 (95% confidence interval 9.84-20.98).


CONCLUSIONS
Peripartum hysterectomy is accompanied by substantial morbidity and mortality. Compared with nonobstetric hysterectomy, the procedure is associated with increased rates of both intraoperative and postoperative complications. The mortality of peripartum hysterectomy is more than 25 times that of hysterectomy performed outside of pregnancy.


METHODS
II.
Wright
Jason D
JD
From the Divisions of Gynecologic Oncology and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York.
Devine
Patricia
P
Shah
Monjri
M
Gaddipati
Sreedhar
S
Lewin
Sharyn N
SN
Simpson
Lynn L
LL
Bonanno
Clarissa
C
Sun
Xuming
X
D'Alton
Mary E
ME
Herzog
Thomas J
TJ
D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000401:mortality*; D007431:Intraoperative Complications / Q000401:mortality; D016017:Odds Ratio; D054238:Perinatal Mortality; D019106:Postoperative Hemorrhage / Q000401:mortality; D011247:Pregnancy; D014481:United States / Q000453:epidemiology; D055815:Young Adult