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Cited by 40Pelvic floor disorders treatmentsUterine Myomas and TreatmentsReproductive Health and Contraception

Association between concomitant hysterectomy and repeat surgery for pelvic organ prolapse repair in a cohort of nearly 100,000 women

Dallas, Kai, Elliott, Christopher S., Syan, Raveen, Sohlberg, Ericka, Enemchukwu, Ekene, Rogo-Gupta, Lisa·2018·Obstetrics & Gynecology
DOI 10.1097/aog.0000000000002913
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Abstract

OBJECTIVE: To evaluate the association of hysterectomy at the time of pelvic organ prolapse (POP) repair with the risk of undergoing subsequent POP surgery in a large population-based cohort. METHODS: Data from the California Office of Statewide Health Planning and Development were used in this retrospective cohort study to identify all women who underwent an anterior, apical, posterior or multiple compartment POP repair at nonfederal hospitals between January 1, 2005, and December 31, 2011, using Current Procedural Terminology and International Classification of Diseases, 9th Revision procedure codes. Women with a diagnosis code indicating prior hysterectomy were excluded, and the first prolapse surgery during the study period was considered the index repair. Demographic and surgical characteristics were explored for associations with the primary outcome of a repeat POP surgery. We compared reoperation rates for recurrent POP between patients who did compared with those who did not have a hysterectomy at the time of their index POP repair. RESULTS: Of the 93,831 women meeting inclusion criteria, 42,340 (45.1%) underwent hysterectomy with index POP repair. Forty-eight percent of index repairs involved multiple compartments, 14.0% included mesh, and 48.9% included an incontinence procedure. Mean follow-up was 1,485 days (median 1,500 days). The repeat POP surgery rate was lower in those patients in whom hysterectomy was performed at the time of index POP repair, 3.0% vs 4.4% (relative risk [RR] 0.67, 95% CI 0.62–0.71). Multivariate modeling revealed that hysterectomy was associated with a decreased risk of future surgery for anterior (odds ratio [OR] 0.71, 95% CI 0.64–0.78), apical (OR 0.76, 95% CI 0.70–0.84), and posterior (OR 0.69, 95% CI 0.65–0.75) POP recurrence. The hysterectomy group had increased lengths of hospital stay (mean 2.2 days vs 1.8 days, mean difference 0.40, 95% CI 0.38–0.43), rates of blood transfusion (2.5% vs 1.5, RR 1.62, 95% CI 1.47–1.78), rates of perioperative hemorrhage (1.5% vs 1.1%, RR 1.32, 95% CI 1.18–1.49), rates of urologic injury or fistula (0.9% vs 0.6%, RR 1.66, 95% CI 1.42–1.93), rates of infection or sepsis (0.9% vs 0.4%, RR 2.12, 95% CI 1.79–2.52), and rate of readmission for an infectious etiology (0.7% vs 0.3%, RR 2.54, 95% CI 2.08–3.10) as compared with those who did not undergo hysterectomy. CONCLUSION: We demonstrate in a large population-based cohort that hysterectomy at the time of prolapse repair is associated with a decreased risk of future POP surgery by 1–3% and is independently associated with higher perioperative morbidity. Individualized risks and benefits should be included in the discussion of POP surgery.

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  • Population-based studies suggest a protective effect of hysterectomy on POP reoperation rates up to 7 years after index surgery.

    “By contrast, population-based studies suggest a protective effect of hysterectomy on POP reoperation rates up to 7 years after index surgery.57,67,68”

    From Hysterectomy versus uterine preservation for pelvic organ prolapse surgery: a prospective cohort study (2025) · cites this paper as [57]

  • A population-based study found hysterectomy was associated with higher risk of perioperative morbidity than uterine-preserving surgery after controlling for age, body mass index, comorbidities, and mesh use, though the analyses could not fully differentiate open from minimally invasive surgeries.

    “A population-based study found hysterectomy was associated with higher risk of perioperative morbidity (eg, hemorrhage, urologic fistula) than UP surgery after controlling for age, body mass index, comorbidities, and mesh use, though the analyses could not fully differentiate open from minimally invasive surgeries.57”

    From Hysterectomy versus uterine preservation for pelvic organ prolapse surgery: a prospective cohort study (2025) · cites this paper as [57]

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Authors
Dallas, K., Elliott, C. S., Syan, R., Sohlberg, E., Enemchukwu, E., & Rogo-Gupta, L.
Affiliations
Santa Clara Valley Medical Center (US)
ORCID
Venue
Obstetrics & Gynecology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2018-12
Volume
132
Issue
6
Pages
1328-1336
ISSN
  • 0029-7844 (ISSN-L)
  • 1873-233X
DOI
10.1097/aog.0000000000002913
OpenAlex
W2896678240
Cited by
40
References
28
Citations by year
2026: 2 · 2025: 7 · 2024: 3 · 2023: 6 · 2022: 7 · 2021: 5 · 2020: 5 · 2019: 4
FWCI
3.00
Type
journal article
Language
en
Open access
closed
Locations
  • Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
  • Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
Keywords
pelvic organ prolapse surgery, hysterectomy, recurrent pelvic organ prolapse, reoperation rate, anterior compartment prolapse, posterior compartment prolapse, mesh use, surgical treatment of incontinence, length of hospital stay, blood transfusion, postoperative complications, surgical outcomes, California women
MeSH terms
Adult, Aged, Blood Transfusion, Female, Humans, Hysterectomy, Length of Stay, Middle Aged, Patient Readmission, Recurrence, Reoperation, Retrospective Studies, Urinary Fistula, Urinary Tract, Sepsis, Postoperative Hemorrhage, Pelvic Organ Prolapse

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