Women who have had at least 1 previous cesarean delivery have an increased risk of complications when undergoing a hysterectomy later in life, according to data published in JAMA Surgery.

Sofie Lindquist, MD, Department of Health and Science Technology, Public Health and Epidemiology Group, Aalborg University, Denmark, and colleagues used data from Danish nationwide registers to determine whether previous cesarean delivery increases the risk of reoperation, perioperative and postoperative complications, and blood transfusions within 30 days of a hysterectomy. Researchers included 7,685 women who gave birth for the first time between 1993 and 2012 and underwent a benign, nongravid hysterectomy between 1996 and 2012.

Results showed that 68.5% of women had no previous cesarean delivery, 22.0% had 1 previous cesarean delivery, and 9.4% had at least 2 previous cesarean deliveries. In addition, 48.3% had an abdominal hysterectomy, 32.7% had a vaginal hysterectomy, and 19.0% had a laparoscopic hysterectomy.

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The investigators found that 5.0% of women had a reoperation within the 30 days after a hysterectomy. The adjusted odds ratio of reoperation for women having 1 previous cesarean delivery compared with women who had vaginal deliveries was 1.31, and the adjusted odds ratio for women with at least 2 previous cesarean deliveries compared with those who had vaginal deliveries was 1.35.

Perioperative and postoperative complications were reported in 12.2% of women and were more frequent among women with previous cesarean deliveries. Compared with women who had no cesarean deliveries, the adjusted odds ratios were 1.16 for 1 previous cesarean delivery and 1.30 for at least 2 cesarean deliveries.

The researchers also note that a blood transfusion was administered to 2.5% of women. Women with at least 2 previous cesarean deliveries had an increased risk of needing a blood transfusion, with an adjusted odds ratio of 1.93 compared with women without a previous cesarean delivery.

“Our results indicate that women with previous cesarean delivery more frequently needed unplanned reoperation within 30 days of a hysterectomy,” the study authors concluded. “This effect may be due to the risk of intra-abdominal adhesions, which increases with the number of cesarean deliveries. The adhesions may complicate future surgery, leading to longer operating time and an increased risk of adverse events, which could result in reoperations.

“Besides the physical risks and emotional stress of having to undergo another operation, reoperations often are followed by treatment in intensive care units, which may induce anxiety, depression, and posttraumatic stress among the affected women.”


Lindquist SA, Shah N, Overgaard C, et al. Association of previous cesarean delivery with surgical complications after a hysterectomy later in life. JAMA Surg. 2017 Aug 9. doi:10.1001/jamasurg.2017.2825