SUBTOTAL HYSTERECTOMY IN MODERN GYNECOLOGY - A DECISION-ANALYSIS

OBJECTIVE: Our purpose was to compare the risks and benefits of subtot al (supracervical) hysterectomy with those of total hysterectomy in wo men at low risk for cervical cancer. STUDY DESIGN: A decision analysis was performed. Baseline probabilities for operative and postoperative morbidity, mortality, and long-term quality of life were established for subtotal and total hysterectomy. RESULTS: Operative complication r ates and ranges for total abdominal hysterectomy were infection 3.0% ( 3.0% to 20.0%), hemorrhage 2.0% (2.0% to 15.4%), and adjacent organ in jury 1.0% (0.7% to 2.0%). Those for subtotal hysterectomy were infecti on 1.4% (1.0% to 5.0%), hemorrhage 2.0% (0.7% to 4.0%), and adjacent o rgan injury 0.7% (0.6% to 1.0%). Operative mortality, the risk for dev elopment of cervicovaginal cancer, and long-term adverse effects on se xual or vesicourethral function were low in both groups. CONCLUSIONS: Recently proposed benefits from subtotal hysterectomy are not well pro ven. Total hysterectomy remains the procedure of choice for most women .