title: FINHYST, a prospective study of 5279 hysterectomies: complications and their risk factors.
abstract: BACKGROUND
  Hysterectomy guidelines highlight an increase in urinary tract injuries with laparoscopic hysterectomy (LH). This national survey analyses complications of LH, abdominal hysterectomy (AH) and vaginal hysterectomy (VH).
  
  
  METHODS
  A prospective cohort undergoing hysterectomy for benign indications during 2006 was drawn from 53 hospitals in Finland; all communal hospitals participated. Detailed questionnaires covered surgical data and intra- and post-operative major and minor complications, for which risk factors were analysed by a multivariate logistic regression model adjusted for surgical data and patient characteristics.
  
  
  RESULTS
  Major complications rates in AH (n= 1255, 24%), LH (1679, 32%) and VH (2345, 44%) were 4.0, 4.3 and 2.6%, and total complications rates were 19.2, 15.4 and 11.7%, respectively. Logistic regression showed no statistically significant differences between approaches for any organ injuries or other major complications. Most bladder and bowel injuries (88 and 83%), but not ureter injuries (10%), were recognized intra-operatively. The ureter injury rate was low after LH (0.3%), as it was after other types of hysterectomy. Compared with LH, AH increased the odds of wound infection, and was an independent risk factor for urinary infections and febrile events. Compared with AH, LH and VH both presented a higher risk for pelvic infection; surgically treated equally often regardless of the type of hysterectomy. No differences in complications emerged between LH and VH. Obesity was a risk factor for many infections. Surgical adhesiolysis [odds ratio (OR) 2.41, 95% confidence interval (CI) 1.38-4.21] was the strongest single risk factor for major complications as a whole. Bladder injury was associated with a history of caesarean section (OR 4.01, 95% CI 2.06-7.83) and with a large uterus ≥500 g (OR 2.88, 95% CI 1.05-7.90), while bowel injury was associated with adhesiolysis (OR 29.07, 95% CI 7.17-117.88).
  
  
  CONCLUSIONS
  FINHYST is a large prospective hysterectomy study illustrating actual complications. Whenever possible, hysterectomy should be minimally invasive.
authors.affiliation: Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Finland. tea.brummer@hus.fi
authors.forename: Tea H I
authors.initials: TH
authors.lastname: Brummer
authors.forename: Jyrki
authors.initials: J
authors.lastname: Jalkanen
authors.forename: Jaana
authors.initials: J
authors.lastname: Fraser
authors.forename: Anna-Mari
authors.initials: AM
authors.lastname: Heikkinen
authors.forename: Minna
authors.initials: M
authors.lastname: Kauko
authors.forename: Juha
authors.initials: J
authors.lastname: Mäkinen
authors.forename: Tomi
authors.initials: T
authors.lastname: Seppälä
authors.forename: Jari
authors.initials: J
authors.lastname: Sjöberg
authors.forename: Eija
authors.initials: E
authors.lastname: Tomás
authors.forename: Päivi
authors.initials: P
authors.lastname: Härkki
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D005260:Female; D005387:Finland; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000706:statistics & numerical data; D007045:Hysterectomy, Vaginal / Q000009:adverse effects*; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology*; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D014551:Urinary Tract / Q000293:injuries