title: Obesity and older age as protective factors for vaginal cuff dehiscence following total hysterectomy.
abstract: Studies have shown an increased risk of vaginal cuff dehiscence following total laparoscopic hysterectomy (TLH). Patient variables associated with dehiscence have not been well described. This study aims to identify factors associated with dehiscence following varying routes of total hysterectomy. This is a retrospective, matched, case-control study of women who underwent a total hysterectomy at a large, urban, university-based teaching hospital from January 2000 to December 2011. Women who underwent a total hysterectomy and had a dehiscence (n= 31) were matched by surgical mode to the next five total hysterectomies (n= 155). Summary statistics and conditional logistic regression were performed to compare cases to controls. Obese women (BMI ≥ 30) were 70 % less likely than normal weight women (BMI < 25) to experience a dehiscence (p= 0.02). When stratified by hysterectomy route, obese women were 86 % less likely to have a dehiscence following robotic-assisted total hysterectomy (RAH) and TLH than normal weight women (p= 0.04). Further, increasing age was protective of dehiscence in this subgroup of women (p= 0.02). Older age and obesity were associated with a decreased risk of dehiscence following RAH and TLH but not following other routes. Increased risk of dehiscence following TLH observed in previous studies may be partially due to patient characteristics.
authors.affiliation: Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Magee-Womens Hospital of UPMC, 300 Halket Street, Pittsburgh, PA 15213 USA.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Donnellan
authors.affiliation: Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Magee-Womens Hospital of UPMC, 300 Halket Street, Pittsburgh, PA 15213 USA.
authors.forename: Suketu
authors.initials: S
authors.lastname: Mansuria
authors.affiliation: School of Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229 USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Aguwa
authors.affiliation: Obstetrics and Gynecology, Stanford University, 900 Blake Wilbur Drive, Palo Alto, CA 94304 USA.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Lum
authors.affiliation: Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, 204 Craft Ave, Pittsburgh, PA 15213 USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Meyn
authors.affiliation: Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Magee-Womens Hospital of UPMC, 300 Halket Street, Pittsburgh, PA 15213 USA.
authors.forename: Ted
authors.initials: T
authors.lastname: Lee
keywords: Dehiscence; Hysterectomy; Laparoscopy; Obesity; Robotic surgery