Postoperative Outcomes and Practices in Vaginal Hysterectomy: A Retrospective Cohort Study and Comparison of General Gynecologists and Urogynecologists.

Abstract

Objective: To evaluate differences in post operative complications and practice patterns amongst vaginal hysterectomy (VH) performed by fellowship-trained urogynecologists compared to general gynecologists.

Methods: This was a retrospective chart review of patients who underwent VH for benign conditions across nine Canadian hospitals (six academic, three community) between July 2016 and November 2022. Post-operative complications and practice patterns were compared between fellowship-trained urogynaecologists compared to general gynaecologists.

Results: A total of 1459 VHs were performed, 691 VH by 10 fellowship-trained urogynaecologist, and 768 VH by 33 general gynaecologists. After adjustment, the odds of post operative complication were not statistically significant between the groups (1.08, 95%CI 0.66 - 1.76). Compared to general gynaecologists, urogynaecologists had no difference in transfusion rates (OR 1.99, 95%CI 0.77-5.12), operative time (median 126min [IQR 77] vs 125 [IQR 98]), and no difference in odds of the composite outcome, any complication or readmission within 30 days of hysterectomy (OR 1.23, 95% CI 0.91 - 1.65). Urogynaecologists did not have a clinically significant increase in estimated blood loss (average 25cc per case). The rates of apical repair were low amongst urogynaecologists and general gynecologists, 57.3% and 28.5% respectively. Of the 33 general gynaecologists, 1 (3%) was new to practice (<5 years).

Conclusion: Major postoperative complications are comparable between general gynecologists and urogynecologists, and general gynecologists should continue to have a robust VH practice to address growing demand. With few new generalists having a VH practice, tailored education is necessary.