Risk Factors Associated with Adnexal Torsion after Hysterectomy

Abstract

<h3>Study Objective</h3> To identify preoperative and intraoperative risk factors for adnexal torsion after hysterectomy, and to estimate the incidence of the disease in the modern-day era of laparoscopic surgery. <h3>Design</h3> Retrospective nested case-control study. <h3>Setting</h3> Large urban medical system. <h3>Patients or Participants</h3> Eighty-nine female patients ages 17-51. <h3>Interventions</h3> Patients underwent ovarian-sparing hysterectomy. <h3>Measurements and Main Results</h3> The estimated incidence of ovarian torsion after hysterectomy was 0.5% (46/8,538 ovarian-sparing hysterectomies). The following variables were found to be associated with adnexal torsion after hysterectomy in an adjusted logistic regression: laparoscopic approach to hysterectomy vs any other approach (OR 3.73 [95% CI: 0.95, 14.59]); younger age at the time of hysterectomy (17-40 years) vs older age (41-51 years) (OR 3.78 [95% CI: 1.39, 10.27]); and a gynecologic history significant for endometriosis (OR 4.46 [95% CI: 1.07, 18.67]). <h3>Conclusion</h3> There is an association between laparoscopic approach to hysterectomy and risk of subsequent adnexal torsion. Providers should have a heightened index of suspicion for adnexal torsion after hysterectomy in patients presenting with acute-onset abdominal pain who underwent laparoscopic hysterectomy at a younger age.