Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States. The Collaborative Review of Sterilization.

Although hysterectomy was the most frequently performed major surgical procedure among women of reproductive age during the past decade, few recent studies have been conducted to determine the risk of complications. We examined data from the Collaborative Review of Sterilization, a prospective, multicenter, observational study coordinated by the Centers for Disease Control, to assess the comparative risks of complications among women undergoing hysterectomy by the abdominal and vaginal approaches. Between September, 1978, and August, 1981, 1,851 women from nine institutions were included in the study. Women who underwent vaginal hysterectomy experienced significantly fewer complications than women who had undergone abdominal hysterectomy. The difference was probably attributable to the prevalence and efficacy of prophylactic antibiotic use among the former group. Vaginal hysterectomy was associated with more unintended major surgical procedures but less febrile morbidity, bleeding requiring transfusion, hospitalization, and convalescence than abdominal hysterectomy. Vaginal hysterectomy with prophylactic antibiotics should be strongly considered for those women of reproductive age for whom either surgical approach is clinically appropriate.