title: Prognostic Factors for Morcellation During Vaginal Hysterectomy.
abstract: OBJECTIVE
  To determine prognostic factors associated with cold-knife morcellation during vaginal hysterectomy.
  
  
  METHODS
  We conducted a retrospective cohort study evaluating all consecutive patients undergoing a vaginal hysterectomy between January 1, 2009, and August 31, 2014. The primary outcome was the utilization of uncontained vaginal morcellation performed using cold-knife wedge resection at the time of vaginal hysterectomy. Secondary outcomes included perioperative data. Significant factors were included in a multivariate logistic regression model to the binary variable vaginal morcellation at the time of vaginal hysterectomy.
  
  
  RESULTS
  A total of 743 women met study inclusion criteria and underwent vaginal hysterectomy with intact uterine removal (n=383) or with uterine morcellation (n=360) with and without other vaginal procedures. A nonparametric Wilcoxon-rank-sum test and χ test were used to compare the cohorts of patients with and without morcellation. Characteristics associated with significantly increased likelihood of morcellation included younger age, non-Caucasian race, American Society of Anesthesiologists class 1 or 2, lower parity, lower number of prior vaginal deliveries, absence of prolapse, presence of leiomyoma, and an enlarged uterus. A multivariate logistic model utilizing factors most likely associated with morcellation revealed lack of prolapse (adjusted odds ratio [OR] 3.87, P<.001), leiomyoma (adjusted OR 2.77, P=.035), and larger uterine weight (adjusted OR 7.25, P<.001) increased the likelihood of morcellation. Prior vaginal delivery was associated with a decreased likelihood of morcellation (adjusted OR 0.79, P=.005).
  
  
  CONCLUSIONS
  Vaginal hysterectomy with morcellation is associated with the following factors: absence of prior vaginal delivery, absence of prolapse, presence of leiomyoma, and a uterus larger than normal size.
authors.affiliation: Department of Gynecologic Surgery and the Division of Health Sciences Research, Mayo Clinic Arizona, Phoenix, Arizona.
authors.forename: Megan
authors.initials: M
authors.lastname: Wasson
authors.forename: Kristina
authors.initials: K
authors.lastname: Butler
authors.forename: Paul
authors.initials: P
authors.lastname: Magtibay
authors.forename: M'hamed
authors.initials: M
authors.lastname: Temkit
authors.forename: Javier
authors.initials: J
authors.lastname: Magrina
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods / Q000706:statistics & numerical data*; D007889:Leiomyoma / Q000601:surgery; D016015:Logistic Models; D008875:Middle Aged; D000069577:Morcellation / Q000295:instrumentation / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D016017:Odds Ratio; D009929:Organ Size; D010298:Parity; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011247:Pregnancy; D011379:Prognosis; D044469:Racial Groups / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D014594:Uterine Neoplasms / Q000601:surgery; D014599:Uterus / Q000473:pathology* / Q000601:surgery