Uterine weight as a predictor of morbidity after a benign abdominal and total laparoscopic hysterectomy
Bonilla, D.J.; Mains, L.; Whitaker, R.; Crawford, B.; Finan, M.; Magnus, M.
Journal of Reproductive Medicine 52(6): 490-498
2007
ISSN/ISBN: 0024-7758 PMID: 17694966 Document Number: 614258
OBJECTIVE: To determine if ail enlarged uterus is associated with an increased rate of intraoperative and postoperative complications and prolonged hospital length of stay (LOS) after benign total abdominal hysterectomy (TAH) or total laparoscopic hysterectomy (TLH).STUDY DESIGN: Women who underwent TAH or TLH werw stratified, according to uterine wcight, into 3 groups: group 1, uterine weight < 200 g; group 2, 201-500 g; and group 3, > 500 g. Indications included uterine leiomyomas, chronic pelvic pain, prolapsed uterus, endometriosis and adenomyosis, dysfunctional uterine bleeding; all had benign final pathology. Statistical analysis compared risks of intraoperative and postoperative morbidity and prolonged hospital stay.RESULTS: Prolonged hospital stay risk increased for uterine weight > 500 g (p <= 0.001). There was a significant association between postoperative complications and uterine size (p 0.001). Mean estimated blood loss (EBL) also increased with uterine weight > 500 g (p <= 0.001). TLH was associated with fewer postoperative complications, shorter LOS and reduced EBL (p <= 0.001).CONCLUSION: Average LOS and risk of blood loss, blood transfusion and other postoperative complications after hysterectomy for benign disease increased with increasing uterine weight. TLH is an excellent alternative for enlarged uteri; it was strongly associated with decreased morbidity, shorter LOS, and reduced EBL and blood transfusion rate in all uterine weight groups when adjusted for other variables.