One-year cohort of abdominal, vaginal, and laparoscopic hysterectomies: Complications and subjective outcomes

Background: In the past decade, changes in operative approaches to hysterec tomy have resulted in needs to renew study of postoperative morbidity. Study Design: This prospective observational study, performed in a universi ty teaching hospital in Finland, was conducted to determine the overall num ber of complications and subjective outcomes after hysterectomy for benign conditions. The population studied during a 1-year period consisted of 687 women, who underwent 516 abdominal hysterectomies, 105 vaginal hysterectomi es, and 66 laparoscopic hysterectomies. Complications arising within 1 year of operations were recorded, and subjective complaints and outcomes were a ssessed using two questionnaire-based evaluations, the first following a co nvalescence period of 4 to 6 weeks, the second after 1 year. Results: Intraoperative complications occurred in 16 patients (2.3%), in 9 patients in the abdominal hysterectomy group (1.7%), and in 4 (3.9%) and 3 patients (4.5%) in the vaginal and laparoscopic hysterectomy groups, respec tively. During the hospital stay postoperative complications were found in 28.5% of patients, in the vaginal hysterectomy group (41.9%) more often tha n in the abdominal and laparoscopic hysterectomy groups (28.3% and 9.1%, re spectively). Postoperative infection, including urinary infection, was the main problem, during both the stay in the hospital and the convalescence pe riod at home. It was also the principal reason for readmission to the hospi tal. Despite an increase in incidence of subjective complaints, from 14.9% during the first evaluation to 37.0% during the second (p < 0.001), 95% of respondents remained satisfied with their operation after 1 year. Conclusions: Vaginal hysterectomy was more often associated with some adver se event, mainly postoperative infection, than abdominal and laparoscopic h ysterectomy. Subjective outcomes were not influenced by the type of hystere ctomy. Most patients were satisfied with the operation on both short- and l ongterm followup. (J Am Cell Surg 1999;189:383-396. (C) 1999 by the America n College of Surgeons).