Perioperative Complications of Hysterectomy After a Previous Cesarean Section: A Systematic Review and Meta-Analysis

BACKGROUND: With increasing rates of cesarean sections (CS), the number of hysterectomies performed among women with a previous CS is on the rise. OBJECTIVE: To provide the association between the odds of complications following a hysterectomy performed later in life and a previous CS. SEARCH STRATEGY: A comprehensive search was performed using major electronic databases, ie, MEDLINE, Scopus, ISI Web of Science, from their inception to April 2019. SELECTION CRITERIA: Analytical studies, irrespective of language or publication status, were included. DATA COLLECTION AND ANALYSIS: Outcomes were extracted in duplicate. The methodological quality of the included studies was independently evaluated by two review authors. A three-level meta-analysis was applied for outcomes with dependent effect sizes. MAIN RESULTS: Twenty-six studies were included involving 54,815 women. The odds of the following complications were increased in women with a previous CS: urinary tract injury (pooled unadjusted odds ratio (OR)=3.15, 95% CI=2.01–4.94, 15 studies, 33,902 women, and pooled adjusted OR=2.21, 95% CI=1.46–3.34, 3 studies, 31,038 women), gastrointestinal tract injury (pooled unadjusted OR=1.73, 95% CI=1.19–2.53; 7 studies, 30,050, and pooled adjusted OR=1.83, 95% CI=1.11–3.03, 1 study, 25,354 women), postoperative infections (pooled unadjusted OR=1.44, 95% CI=1.22–1.71, 6 studies, 37,832 women), wound complications (pooled unadjusted OR=2.24, 95% CI=1.94–2.57, 9 studies, 37,559 women), reoperation (pooled unadjusted OR=1.46, 95% CI=1.19–1.78, 2 studies, 9,899 women), and blood transfusion (pooled unadjusted OR=1.35, 95% CI=1.03–1.76, 7 studies, 13,430 women). CONCLUSION: Previous CS increases risks of various complications following hysterectomy. This information reminds the gynecologists to be aware of the associations between previous CS and potential complications among women undergoing hysterectomy. PROSPERO REGISTRATION NUMBER: CRD42018085061.