McPherson, K., Metcalfe, M. A., Herbert, A., Maresh, M., Casbard, A., Hargreaves, J., Bridgman, S. and Clarke, Aileen (2004) Severe complications of hysterectomy : the VALUE study. BJOG: An International Journal of Obstetrics and Gynaecology, 111 (7). pp. 688-694. doi:10.1111/j.1471-0528.2004.00174.x ISSN 1470-0328.

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Abstract

Objectives: To model the determinants of serious operative and post-operative complications of hysterectomy and their potential risk factors.

Design: A prospective cohort of women undergoing hysterectomies for benign indications in 1994/1995, with a six-week postsurgery follow up.

Population and setting: A total of 37,512 women from 276 NHS and 145 private hospitals in England, Wales and Northern Ireland, originally recruited to compare the outcomes of endometrial destruction with those of hysterectomy.

Methods: Gynaecologists reported hysterectomies for non-malignant indications carried out during a 12-month period beginning in October 1994 and follow up data were obtained at outpatient follow up six weeks postsurgery. Odds ratios of severe complications by indication and method, adjusting for measured intrinsic risk factors, were calculated.

Main outcome measures: Severe operative and post-operative complications.

Results: Severe operative complications occurred in 3%. The risk decreased with age and increased with greater parity and history of serious illness. Women with symptomatic fibroids (4.4%, 95% CI 3.9–4.9) experienced more complications than women with dysfunctional uterine bleeding (3.6%, 3.2–3.8), adjusted odds ratio (OR) = 1.3 (95% CI 1.1–1.6). Laparoscopic procedures (6.1%) doubled the risk of operative complications of abdominal hysterectomy (3.6%) (adjusted OR = 1.9, 1.5–2.5). Post-operative complications occurred in around 1% of women, with a slight decrease with increasing age, and the strongest risk factor was a history of operative complications. Relative to dysfunctional uterine bleeding (1.0%), a higher risk for fibroids (1.2%) persisted after adjustments (RR = 1.5, 1.1–2.0). Both vaginal (1.2%) and laparoscopic (1.7%) techniques had significantly higher adjusted risks than abdominal operations (0.9%), RR = 1.4 (1.0–1.9) and RR = 1.6 (1.0–2.7). There were no operative deaths; 14 women died within the six-week postsurgery (a crude mortality rate of 3.8/1000, 2.5–6.4).

Conclusions: Hysterectomy is a common, routine surgery with comparatively rare serious complications. However, younger women, women with more vascular pelvises, who undergo hysterectomy, especially laparoscopically assisted vaginal surgery for symptomatic fibroids, are at most risk of experiencing severe complications both operatively and post-operatively. Therefore, a less invasive alternative treatment for symptomatic fibroids could particularly benefit this group of women, while less invasive treatments for dysfunctional uterine bleeding, such as various methods of endometrial ablations or resections, would need to meet the current low levels of clinical complications in order to replace hysterectomy.

Item Type:	Journal Article
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Journal or Publication Title:	BJOG: An International Journal of Obstetrics and Gynaecology
Publisher:	Blackwell Publishing
ISSN:	1470-0328
Official Date:	July 2004
Dates:	Date Event July 2004 Published
Volume:	111
Number:	7
Page Range:	pp. 688-694
DOI:	10.1111/j.1471-0528.2004.00174.x
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)

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