Risk Factors for Vaginal Cuff Dehiscence Following Total Hysterectomy: A Retrospective Cohort Study of 11,163 Women

INTRODUCTION: Vaginal cuff dehiscence (VCD) is a rare but serious complication of total hysterectomy. Reported incidences of VCD vary, and the surgical techniques and patient characteristics that predispose patients to VCD are not well defined. Given that hysterectomy is the most common non-obstetrical surgery performed on women, better understanding of this serious complication is necessary. OBJECTIVE: The objective was to determine which patient characteristics, surgical technique and materials, and hysterectomy route were associated with VCD. METHODS: This was a retrospective cohort study examining hysterectomies performed at two hospitals of an academic institution between 2013 and 2021 for benign or malignant indications. Supracervical or cesarean hysterectomies were excluded. After a comprehensive review of the electronic medical records, baseline patient characteristics, route of hysterectomy, as well as intraoperative variables including cuff closure technique and material were compared between women who had VCD and who did not. Multivariate logistic regression analysis was used to adjust for significantly different patient characteristic using SSPS 29.0. RESULTS: A total of 11,163 total hysterectomies were identified. The overall incidence of VCD was 1.0%, with a total of 110 VCD cases identified. Patients with VCD were younger (47 vs 51 years, p=<0.001) and had a lower body mass index (BMI) (27.0 vs 29.5 kg/m2, p=0.007). Patients who underwent laparoscopic hysterectomy (LH) and robotic-assisted laparoscopic hysterectomy (RA-LH) had the highest rates of VCD, at 1.2% and 1.3%, respectively. Vaginal hysterectomy (VH) had the lowest risk of VCD, at 0.2%. Closing the cuff with interrupted suture had a lower risk of VCD as compared with continuous suture (adjusted odds ratio 0.38, p=0.01). Suture type or size did not affect the risk of VCD (Tables 1 and 2). CONCLUSIONS: In this largest single-institution cohort of VCD, we found that the incidence of VCD is 1%, which mostly accounted for the increased risk with LH and RA-LH. The risk of VCD is lowest in patients who underwent VH and who had the cuff closed with interrupted suture. Age at the time of hysterectomy and BMI were independently associated with increased risk of VCD.