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Cesarean delivery significantly increases risk for hysterectomy complications

The risk for reoperation and complications among women undergoing a hysterectomy later in life was substantially greater in women who previously had a cesarean delivery, according to findings recently published in JAMA Surgery.

“The results of previous studies on the effect of cesarean deliveries on subsequent hysterectomies suggest that a prior cesarean delivery may be related to lower urinary tract injuries, increased intraoperative and postoperative blood transfusion, and readmission within 30 days of a hysterectomy,” Sofie A.I. Lindquist, MD, of the department of health science and technology, Aalborg University in Denmark, and colleagues wrote. “However, these studies are limited to single-institution investigations.”

Researchers added that the high occurrence of hysterectomy later in life makes it a “useful proxy” for looking into long-term surgical complications connected to earlier cesarean deliveries, which account for an estimated 18.6% of births worldwide.

Lindquist and colleagues studied a cohort of 7,685 women throughout Denmark who had a benign, nongravid hysterectomy between Jan. 1, 1992 and Dec. 31, 2012 to evaluate the impact cesarean delivery may have on risk for reoperation, perioperative and postoperative complications, and risk for blood transfusion within 30 days after undergoing a benign hysterectomy.

Of the women studied, 5,267 had no previous cesarean delivery; 1,694 had one cesarean delivery; and 724 had two or more cesarean deliveries. Further, 3,714 had an abdominal hysterectomy; 2,513 had a vaginal hysterectomy, and 1,458 had a laparoscopic hysterectomy.

Researchers found that perioperative and postoperative complications were chronicled in 934 women (12.2%) and were more likely to occur in women with previous cesarean deliveries, with adjusted OR of 1.16 (95% CI, 0.98-1.37) for one cesarean delivery and 1.3 (95% CI, 1.02-1.65) for two or more cesarean deliveries. Blood transfusions were provided to 195 (2.5%) women. Women who had two or more cesarean deliveries had adjusted OR for receiving blood transfusion of 1.93 (95% CI, 1.21-3.07) compared with women who never had a cesarean delivery.

Of the total cohort, 388 women had a reoperation within 30 days after a hysterectomy. When compared with women having vaginal deliveries, fully adjusted multivariable analysis showed that the adjusted OR of reoperation for women having one previous cesarean delivery was 1.31 (95% CI, 1.03-1.68), and the adjusted OR was 1.35 (95% CI, 0.96-1.91) for women having two or more cesarean deliveries.

“Our results imply that information on long-term associations should be made more readily available to women, clinicians, and policymakers and suggest that decisions on cesarean delivery should take into account not only immediate maternal and neonatal influences but also women’s health in the long term,” Lindquist and colleagues wrote. “The results support policies and clinical efforts to prevent cesarean deliveries that are not medically indicated.” – by Janel Miller

Disclosure: Lindquist reports no relevant financial disclosures. Please see the study for a full list of the other researchers’ relevant disclosures.