Table 19Modifiers of hysterectomy outcomes

Author, YearDesign, Intervention, ModifiersNResults
Dessole et al., 2000158RCT of abdominal hysterectomy with CT vs. abdominal hysterectomy with BESCT: 25Operating time (min, mean ± SD)
Modifiers: use of CT vs. BESBES: 25CT: 121 ± 32
BES: 90 ± 15
P < 0.01
Ligations (mean ± SD)
CT: 14 ± 4
BES: 6 ± 2
P < 0.01
Hgb concentration not significantly different preoperatively, day 1 postoperative, day 2 postoperative
Hgb concentration day 5 postoperative (g/dL, mean ± SD):
CT: 10.0 ± 1.4
BES: 10.4 ± 1.1
P < 0.001
Hct not significantly different preoperatively, day 1 postoperative, day 2 postoperative
Hct day 5 postoperative (%, mean ± SD):
CT: 32.5 ± 3.3
BES: 34.0 ± 3.1
P < 0.001
Ferrari et al., 2000160RCT of LAVH vs. TAHLAVH: 31Uterine weight significant predictor of conversion to laparotomy
Modifiers: uterine size (≤ 500 g and > 500 g)TAH: 31LAVH (uterine size ≤ 500 g): 0/20
LAVH (uterine size > 500 g): 3/11
P = 0.04
Okin et al., 2001163RCT of abdominal hysterectomy with vasopressin vs. placeboVasopressin: 30Total estimated blood loss (mL ± SD)
Modifiers: use of vasopressin vs. placeboPlacebo: 27Vasopressin: 445.41 ± 239.99
Placebo: 748.42 ± 296.97
P = 0.001
Hysterectomy-related estimated blood loss (mL ± SD)
Vasopressin: 410.63 ± 227.76
Placebo: 690.21 ± 294.76
P =0.001
Vasopressin vs. placebo not significant predictor of postoperative hemoglobin, change in hemoglobin, intraoperative transfusion, total operating room time, hysterectomy time, stay ≥ 4 days
Unger et al., 2002167Retrospective case series of abdominal hysterectomyUterus < 500 g: 208At least one complication (EBL > 500 mL, perioperative blood transfusion, major organ injury, postoperative antibiotic therapy, readmission) (n,%)
Modifiers:Uterus 500–999 g: 63Uterus < 500 g: 68 (32.7)
Uterus < 500 gUterus ≥ 1,000 g: 47Uterus 500–999 g: 26 (41.3)
Uterus 500–999 gUterus ≥ 1,000 g: 29 (61.7)
Uterus ≥ 1,000 gP = 0.006
AOR for G3 vs. G1: 3.42 (1.63, 7.25)
AOR for G3 vs. G2: 2.64 (1.14, 6.13)
Dousias et al., 200347RCT of preoperative therapy before total abdominal hysterectomy of rHuEPO 600 U/ml SC plus iron supplementation once weekly for 3 weeks vs. only iron supplementationrHuEPO plus iron: 23No difference in Hgb levels at day -7, 0. Higher Hgb levels at days 3, 7, and 14 postoperatively in the rHuEPO plus iron group
Modifiers: rHuEPO plus iron supplementation vs. iron aloneIron alone: 27No difference in blood loss or length of hospital stay
Blood transfusion (n,%)
rHuEPO plus iron: 0
iron alone: 5 (21.7)
P < 0.05
Spies et al., 200494Nonrandomized prospective cohort of UAE vs. hysterectomy (abdominal, LAVH, laparoscopic)UAE: 102Uterine volume, previous therapies, age, and race were not significant predictors of perioperative complications
Modifiers: uterine volume, previous therapies, age, and raceHysterectomy: 50
Paparella et al., 2004164Prospective case series of vaginal hysterectomy in generally considered contraindications to vaginal surgery204Large uterus, adnexal pathology, nulliparity, previous pelvic surgery, more than one contraindication are not significant predictors of complications
Modifiers: large uterus, adnexal pathology, nulliparity, previous pelvic surgery, more than one contraindication
Hehenkamp et al., 200576RCT of UAE vs. hysterectomy (abdominal, vaginal, LAVH, laparoscopic)UAE: 88Radiologists' experience with UAE not associated with the technical failure rate
Modifiers: radiologists' experience, hospital experience, type of hysterectomyHysterectomy: 89Less-experienced hospitals not associated with higher complication or readmission rates
Overall major and minor complication rates do not differ significantly in subset of abdominal hysterectomies (P = 0.28 and P = 0.70)

AOR, adjusted odds ratio; BES, bipolar electrocautery scissors; CT, conventional technique; EBL, estimated blood loss; g, gram; g/dL, grams per deciliter; Hgb, hemoglobin; LAVH, laparoscopically assisted vaginal hysterectomy; mL, milliliter; RCT, randomized controlled trial; rHuEPO, recombinant human erythropoietin; SD, standard deviation; TAH, total abdominal hysterectomy; UAE, uterine artery embolization; U/ml, units per milliliter; vs., versus.

From: 3, Results

Cover of Management of Uterine Fibroids
Management of Uterine Fibroids: An Update of the Evidence.
Evidence Reports/Technology Assessments, No. 154.
Viswanathan M, Hartmann K, McKoy N, et al.

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