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JAMA Surg. 2017 Dec 1;152(12):1148-1155. doi: 10.1001/jamasurg.2017.2825.

Association of Previous Cesarean Delivery With Surgical Complications After a Hysterectomy Later in Life.

Author information

1
Department of Health Science and Technology, Public Health and Epidemiology Group, Aalborg University, Aalborg Øst, Denmark.
2
Ariadne Labs at Brigham and Women's Hospital and the Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
3
Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark.
4
Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark.

Abstract

Importance:

In recent decades, the global rates of cesarean delivery have rapidly increased. Nonetheless, the influence of cesarean deliveries on surgical complications later in life has been understudied.

Objective:

To investigate whether previous cesarean delivery increases the risk of reoperation, perioperative and postoperative complications, and blood transfusion when undergoing a hysterectomy later in life.

Design, Setting, and Participants:

This registry-based cohort study used data from Danish nationwide registers on all women who gave birth for the first time between January 1, 1993, and December 31, 2012, and underwent a benign, nongravid hysterectomy between January 1, 1996, and December 31, 2012. The dates of this analysis were February 1 to June 30, 2016.

Exposure:

Cesarean delivery.

Main Outcomes and Measures:

Reoperation, perioperative and postoperative complications, and blood transfusion within 30 days of a hysterectomy.

Results:

Of the 7685 women (mean [SD] age, 40.0 [5.3] years) who met the inclusion criteria, 5267 (68.5%) had no previous cesarean delivery, 1694 (22.0%) had 1 cesarean delivery, and 724 (9.4%) had 2 or more cesarean deliveries. Among the 7685 included women, 3714 (48.3%) had an abdominal hysterectomy, 2513 (32.7%) had a vaginal hysterectomy, and 1458 (19.0%) had a laparoscopic hysterectomy. In total, 388 women (5.0%) had a reoperation within 30 days after a hysterectomy. Compared with women having vaginal deliveries, fully adjusted multivariable analysis showed that the adjusted odds ratio of reoperation for women having 1 previous cesarean delivery was 1.31 (95% CI, 1.03-1.68), and the adjusted odds ratio was 1.35 (95% CI, 0.96-1.91) for women having 2 or more cesarean deliveries. Perioperative and postoperative complications were reported in 934 women (12.2%) and were more frequent in women with previous cesarean deliveries, with adjusted odds ratios of 1.16 (95% CI, 0.98-1.37) for 1 cesarean delivery and 1.30 (95% CI, 1.02-1.65) for 2 or more cesarean deliveries. Blood transfusion was administered to 195 women (2.5%). Women having 2 or more cesarean deliveries had an adjusted odds ratio for receiving blood transfusion of 1.93 (95% CI, 1.21-3.07) compared with women having no previous cesarean delivery.

Conclusions and Relevance:

Women with at least 1 previous cesarean delivery face an increased risk of complications when undergoing a hysterectomy later in life. The results support policies and clinical efforts to prevent cesarean deliveries that are not medically indicated.

PMID:
28793157
PMCID:
PMC5831435
DOI:
10.1001/jamasurg.2017.2825
[Indexed for MEDLINE]
Free PMC Article

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