Early complications of abdominal and vaginal hysterectomy.

In 1982, the Collaborative Review of Sterilization (CREST) study was published, reviewing the complications accompanying and following both abdominal and vaginal hysterectomy. This review was undertaken to see how these rates have changed in the ensuing years. All large series of abdominal and vaginal hysterectomy complications published subsequent to the CREST study were reviewed. Additionally, other studies that focused on specific complications were reviewed. It is concluded that the following changes related to hysterectomy morbidity have occurred since the publication of the CREST study: 1) the use of blood transfusion has diminished due to concern regarding human immunodeficiency virus contamination; 2) the rate of urinary tract infection has decreased primarily due to routine use of prophylactic antibiotics; and 3) inadvertent injury to the bladder has been noted more frequently at a rate of 1 to 2 percent. A particularly important category of complication is "unintended major surgical procedures which accompany or follow hysterectomy." This has been shown to occur at a rate of approximately 4 percent on general gynecology services. Finally, risk factors that add to the morbidity of hysterectomy are discussed.