Abdominal hysterectomy and high frailty score are associated with complications among older patients

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Objective: To evaluate effects of frailty and hysterectomy route on 30-day postoperative morbidity for older hysterectomy patients. Methods: Participants included patients in the American College of Surgeons' National Surgical Quality Improvement Program database aged 60 years or older and undergoing simple hysterectomy from 2014 to 2018. The Five-Factor Modified Frailty Index approximated frailty: women with scores of 3 or more, indicating more severe comorbidities, were considered frail. Logistic regression multivariable models with and without an interaction term were used to study the independent and interactive effects of frailty and route on postoperative complications. Results: Of 19 888 hysterectomies, 4356 (21.9%) were abdominal, 13 382 (67%) were laparoscopic, and 2150 (10.8%) were vaginal, with 251 (1.3%) frail patients. Frailty (odds ratio [OR] 1.89, 95% confidence interval [CI] 1.32–2.70, P = 0.001) and abdominal versus laparoscopic hysterectomy (OR 2.14, 95% CI 1.88–2.45, P < 0.001) increased complication odds. Assessing interaction, complication odds for abdominal versus laparoscopic hysterectomy were higher for frail patients (OR 4.12, 95% CI 1.96–8.67, P < 0.001) versus non-frail patients (OR 2.10, 95% CI 1.84–2.40). Conclusion: Frail older patients have increased risk for hysterectomy complications, especially with abdominal hysterectomy versus laparoscopic hysterectomy. A frailty index can be a useful preoperative tool to guide counseling and route choice.

Original languageEnglish (US)
Pages (from-to)544-550
Number of pages7
JournalInternational Journal of Gynecology and Obstetrics
Issue number3
StatePublished - Sep 2022


  • American College of Surgeons National Surgical Quality Improvement Program (NSQIP)
  • abdominal hysterectomy
  • frailty
  • hysterectomy
  • laparoscopic hysterectomy
  • minimally invasive
  • older patient
  • perioperative complications
  • readmission
  • risk factors
  • surgical routes
  • vaginal hysterectomy

ASJC Scopus subject areas

  • Obstetrics and Gynecology


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