Elective Cesarean Hysterectomy versus Elective Cesarean Section Followed by Remote Hysterectomy: Reassessing the Risks

ABSTRACT

The purpose of this study was to compare the risks of elective cesarean hysterectomy with those of elective cesarean section followed by remote hysterectomy. A census of elective cesarean hysterectomies (n = 31) and a random sample of 200 cesarean sections and 200 hysterectomies performed by the authors between 1987 and 1996 were evaluated. Only elective repeat and primary cesarean section patients without labor were selected for study (n = 86). Total abdominal hysterectomies were drawn from the sample (n = 60), excluding patients with cancer, those over 50 years old, and those undergoing ancillary procedures other than adnexectomy and lysis of adhesions. General probability theory was used to calculate a predicted complication rate of cesarean section followed by total abdominal hysterectomy (TAH) from the complication rates of the component procedures done independently. This predicted combined complication rate was then compared with the observed rate of complications from cesarean hysterectomy to evaluate the risks of the two alternative treatment regimens. Elective cesarean section and TAH had complication rates of 12.8% and 13.4%, respectively. The predicted combined complication rate for elective cesarean section followed by TAH was 24.5%. The observed rate of complications for elective cesarean hysterectomy was much lower (16.1%). Although bleeding complications were similar for the two regimens, the rate of transfusion was higher for cesarean hysterectomy (13.0%) than for cesarean section (0%) and TAH (3.4%) alone. Eighty percent of the cesarean hysterectomy patients would have been candidates for autologous blood donation, had it been available. Elective cesarean hysterectomy appears to have a lower risk of complications than elective cesarean section followed by remote abdominal hysterectomy. The risks of transfusion are higher for cesarean hysterectomy but can be decreased by the use of autologous blood. (J GYNECOL SURG 14:161, 1998)