Optimizing Hysterectomy in Older Women: Indications,Surgical Approaches,and Postoperative Outcomes

Abstract

Objective:

Hysterectomy remains a frequently performed procedure in older women, yet limited data exist on the benign indications and surgical patterns among women aged 60 years and above. While minimally invasive surgery is increasingly favored, few studies describe concurrent pelvic floor repairs or perioperative outcomes in this population. Our aim is to describe patient characteristics, surgical indications, operative approaches, concurrent procedures, and early outcomes in women aged 60 and above undergoing hysterectomy for benign conditions.

Materials and Methods:

This retrospective descriptive study used data from the 2021 American College of Surgeons National Surgical Quality Improvement Program. We included women aged ≥60 years who underwent simple hysterectomy and excluded those with malignancy or concurrent procedures performed by nonprimary surgical teams. We identified benign conditions using ICD-10 codes, including pelvic organ prolapse (POP), uterine fibroids, postmenopausal bleeding, benign ovarian neoplasms and cysts, pelvic pain, and endometriosis. We assessed demographic data, comorbidities, surgical approaches, concurrent procedures, and 30-day postoperative complications.

Results:

Among 4983 women aged ≥60 years, POP was the leading indication (52%), followed by fibroids (18%) and benign neoplasms/cysts (16%). Most hysterectomies were performed vaginally (41%) or laparoscopically (40%). Same-day discharge occurred most often with laparoscopic hysterectomy (50%). Vaginal hysterectomy was associated with the highest rate of concurrent pelvic floor repairs (84%). Urinary tract infection (4%) was the most common complication.

Conclusions:

Among older women undergoing hysterectomy for benign indications, vaginal and laparoscopic approaches are most commonly employed, often in the context of POP and concurrent pelvic floor repairs. These findings underscore the importance of individualized and comprehensive surgical planning in this population.