Overcoming barriers to vaginal hysterectomy: An analysis of perioperative outcomes

Objective: To determine perioperative outcome differences in patients undergoing vaginal hysterectomy based on uterine weight, vaginal delivery, and menopausal state. Material and Methods: Retrospective chart review of 452 patients who underwent vaginal hysterectomy performed by a single surgeon. Patients' age, vaginal delivery, uterine weight, previous pelvic surgery, previous cesarean delivery, removal of ovaries were compared, as well as estimated blood loss (EBL), operating room time (ORT), length of stay, intraoperative complications and postoperative complications. Multivariable logistic regression was used, and all data were analyzed at the level of p<0.05 statistical significance using SAS system software (SAS Institute Inc., Cary, NC), version 9.3. Results: The mean age was 57.13 +/- 11.52 years and the median vaginal delivery was 2. The uterine weight range was 16.6-1174.5 g (mean 169.79 +/- 183.94 g). The incidences of blood transfusion and bladder injury were 3.03% and 0.66%, respectively. Factors shown to be associated with longer ORT included greater uterine weight, removal of ovaries, posterior repair, tension-free vaginal tape sling, prolapse, and EBL >500 mL (p<0.001). The factors associated with EBL >500 mL were greater uterine weight (p=0.001), uterine myomas (p=0.016) and premenopausal state (p=0.014). The factors associated with conversion to laparotomy were greater uterine weight (p<0.001) and premenopausal state (p<0.001). Conclusion: Vaginal hysterectomy is a safe and feasible approach for patients desiring hysterectomy regardless of uterine weight and vaginal delivery.