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Outcomes of Vaginal Hysterectomy With and Without Perceived Contraindications to Vaginal Surgery

Schmitt, Jennifer J., DO, MS*; Occhino, John A., MD, MS*; Weaver, Amy L., MS; McGree, Michaela E., BS; Gebhart, John B., MD, MS*

Female Pelvic Medicine & Reconstructive Surgery: January/February 2019 - Volume 25 - Issue 1 - p 41–48
doi: 10.1097/SPV.0000000000000469
Original Articles

Objective The aim of this study was to compare outcomes of vaginal hysterectomy between patients with and without the following perceived contraindications to vaginal surgery: uterine weight greater than 280 g, prior cesarean delivery, no vaginal parity, and obesity.

Methods Retrospective cohort of benign vaginal hysterectomies between 2009 and 2013 was obtained. Outcomes included uterine debulking, transfusion, intraoperative complications, length of stay, and Accordion grade 2+ postoperative complications. For each outcome, the association between the presence of each contraindication and the outcome was evaluated using univariate and multivariate logistic regression models.

Results Among 692 vaginal hysterectomies, 11% (76/691) had a uterine weight greater than 280 g, 11.3% (78/690) had no vaginal parity, 14.9% (103/690) had a history of cesarean delivery, and 37.7% (248/657) had a body mass index of 30 kg/m2 or greater; 110 (15.9%) had 2 or more contraindications. Uterine debulking occurred in 146 women (21.1%), and both uterine weight greater 280 g (adjusted odds ratio, 39.2; 95% confidence interval, 18.4–83.5) and prior cesarean delivery (adjusted odds ratio, 2.1; 95% confidence interval, 1.2–3.7) were significantly associated with an increased likelihood of uterine debulking after adjusting for age, hematologic disease, and preoperative diagnosis. None of the contraindications were significantly associated with need for a blood transfusion, presence of an intraoperative complication, length of stay greater than 2 days, or presence of an Accordion grade 2+ postoperative complication, which occurred in 2.7%, 2.5%, 14.0%, and 6.9% of all women, respectively.

Conclusions Vaginal hysterectomy can be safely performed with favorable outcomes, even in women with a uterus greater than 280 g, prior cesarean delivery, no vaginal parity, and obesity. Our findings challenge several perceived contraindications to vaginal hysterectomy.

Vaginal hysterectomy can be safely performed, even with a uterine weight greater than 280 g, no vaginal parity, history of cesarean delivery, or obesity.

From the *Division of Gynecologic Surgery; and

Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.

Correspondence: Jennifer J. Schmitt, DO, MS, Division of Urogynecology, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail:

Disclosures: Dr Gebhart is supported by Royalties from UpToDate, Inc, and Elsevier BV. The other authors declare no conflict of interest.

Presentation: Presented as an oral presentation at the annual meeting of the Central Association of Obstetricians and Gynecologists, Las Vegas, NV, October 26–29, 2016.

Source of Funding: This publication was supported by Center for Translational Science Activities Grant Number UL1 TR000135 from the National Center for Advancing Translational Science. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

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