Abstract WP284: Assessment of Stroke Risk Following Hysterectomy: A Meta Analysis of Prospective Studies

Abstract

Background: Hysterectomy is one of the most prevalent gynecological procedures in the United States. The risk of stroke following hysterectomy remains unclear. While some studies suggest a possible increase in stroke risk, others have shown inconsistent results. Aim: This meta-analysis aims to evaluate the risk of stroke following hysterectomy procedures. Methods: We systematically searched PubMed, Embase and Google Scholar to identify studies that evaluated the occurrence of stroke in hysterectomized patients using database-specific queries via combination of controlled vocabulary from the earliest available data to July, 2023. HRs (hazard ratios) and 95% CI were extracted from the included studies. The analysis was conducted using R (4.3.1). Extracted hazard ratios were log transformed, including their confidence intervals. The combined effect size was computed using the inverse variance pooling method. The random-effects models were utilized to assess the overall effect. I2 statistic evaluated the statistical heterogeneity, and the DerSimonian-Laird estimator quantified the between-study variance. Results: A total of 6 cohort studies were included, which evaluated the risk of stroke with a total of 772707 patients, out of which 138188 patients (17.88%) underwent hysterectomy procedures. The pooled aHR of hysterectomised patients was 1.21 (95% CI: 1.05-1.40; p &lt 0.01). Significant heterogeneity was noted in the outcome (I2 = 82%). 2 studies that reported the data for each stroke subtype yielded a pooled aHR 0.98 (95% CI: 0.89-1.09; I2 = 67%; p = 0.08) for hemorrhagic stroke while a pooled aHR = 0.98; 95% CI: 0.89-1.20; I2 = 0%; p = 0.66) for ischemic stroke. Conclusion: Our analysis reveals an elevated stroke risk post-hysterectomy. While more prospective studies are required to strengthen the evidence for the same, this meta-analysis underscores monitoring for stroke risk factors in hysterectomised patients.