Obesity and older age as protective factors for vaginal cuff dehiscence following total hysterectomy.

Nicole M Donnellan,Ted Lee,Leslie Meyn,Deirdre Lum,Suketu Mansuria,Nancy Aguwa

doi:10.1007/s10397-015-0882-8

Abstract

Studies have shown an increased risk of vaginal cuff dehiscence following total laparoscopic hysterectomy (TLH). Patient variables associated with dehiscence have not been well described. This study aims to identify factors associated with dehiscence following varying routes of total hysterectomy. This is a retrospective, matched, case-control study of women who underwent a total hysterectomy at a large, urban, university-based teaching hospital from January 2000 to December 2011. Women who underwent a total hysterectomy and had a dehiscence (n = 31) were matched by surgical mode to the next five total hysterectomies (n = 155). Summary statistics and conditional logistic regression were performed to compare cases to controls. Obese women (BMI ≥ 30) were 70 % less likely than normal weight women (BMI < 25) to experience a dehiscence (p = 0.02). When stratified by hysterectomy route, obese women were 86 % less likely to have a dehiscence following robotic-assisted total hysterectomy (RAH) and TLH than normal weight women (p = 0.04). Further, increasing age was protective of dehiscence in this subgroup of women (p = 0.02). Older age and obesity were associated with a decreased risk of dehiscence following RAH and TLH but not following other routes. Increased risk of dehiscence following TLH observed in previous studies may be partially due to patient characteristics.

Highlights

As the number of laparoscopic hysterectomies performed each year increases [1, 2], complications associated with this procedure are becoming more evident
From January 2000 through December 2011, there were 31 cases of vaginal cuff dehiscence that presented to MageeWomens Hospital following a total hysterectomy initially performed at our institution
Black women had a four-fold increased risk of dehiscence compared to other races (p=0.03; Table 2). This is the first study to demonstrate that patient characteristics of age, body mass index (BMI), and race are significantly associated with vaginal cuff dehiscence following total hysterectomy

Summary

Introduction

As the number of laparoscopic hysterectomies performed each year increases [1, 2], complications associated with this procedure are becoming more evident One such complication, vaginal cuff dehiscence, has been studied extensively, and numerous reports have described rates of dehiscence to be higher in patients undergoing total laparoscopic hysterectomy (TLH) and robotic-assisted total hysterectomy (RAH) compared to the abdominal or vaginal route [3,4,5,6,7,8,9]. While attempts to investigate the relationship of these factors with dehiscence have been reported, results in the literature remain controversial [11,12,13] and confusion surrounding the etiology of vaginal cuff dehiscence persists

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