Complications Associated With Hysterectomy at the Time of Obliterative Surgery

Given the large incidence of uterovaginal prolapse among parous women and high utilization of obliterative surgical procedures among the elderly, a clear understanding of the risk profile associated with concomitant hysterectomy is critical to guide surgical decision making.

The objective of this study was to compare 30-day postoperative complications between obliterative surgery with or without concomitant hysterectomy for the treatment of uterovaginal prolapse.

This was a large retrospective cohort study, which identified patients undergoing an obliterative surgery with or without concurrent hysterectomy in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Database (2015-2022) using Current Procedural Terminology codes. The primary outcome was any 30-day complication, defined as a composite of any ACS NSQIP-tracked postoperative complication. Secondary outcomes included major complications, minor complications, readmission, and reoperation.

A total of 4,040 patients were included in the analysis, with 3,497 (86.6%) undergoing LeFort colpocleisis and 543 (13.4%) undergoing obliterative surgery (colpocleisis or vaginectomy) with hysterectomy. LeFort colpocleisis patients were significantly older (76.7 vs 74.7 y, P<0.001) and had lower body mass index (27.2 vs 28.2, P<0.001). The rate of 30-day complications was 6.9%, and the rate of major complications was 6.2%. The rate of any adverse event (postoperative complications, readmission, and reoperation) did not differ between groups. On multivariable logistic regression controlling for potential confounders, obliterative surgery with hysterectomy was not associated with increased odds of any postoperative complication compared with LeFort colpocleisis.

The addition of hysterectomy to obliterative surgery for uterovaginal prolapse is not associated with increased odds of any postoperative complications within 30 days of surgery.