Publication:

A longitudinal study on short- and long-term complications following hysterectomy: a comparative analysis between abdominal and vaginal routes in women aged over 30 years at a tertiary care hospital in Puducherry, India

Background Hysterectomy remains one of the most commonly performed gynaecological procedures worldwide. Understanding the short- and long-term complication profiles of abdominal hysterectomy (AH) and vaginal hysterectomy (VH) is essential for guiding surgical decision-making, particularly in resource-limited settings. This study aimed to compare short-term (≤30 days) and long-term (≤6 months) postoperative complications between AH and VH and to identify patient- and surgery-related predictors of postoperative morbidity.

Methods A prospective longitudinal study was conducted among 110 women aged >30 years undergoing AH or VH at a tertiary care hospital. Participants were followed at regular intervals for six months. Baseline characteristics, intraoperative parameters, and postoperative complications were recorded. Group comparisons were performed using Chi-square and independent t-tests. Predictors of complications were examined using multivariable logistic regression.

Results Baseline demographic and clinical characteristics were comparable between groups. VH was associated with significantly shorter operative time, lower blood loss, and reduced need for blood transfusion compared with AH. Short-term complications particularly wound infection and prolonged hospital stay were more common following AH. Long-term complications did not differ significantly between groups, with similar rates of chronic pelvic pain, urinary symptoms, and psychological distress. Higher BMI (≥28 kg/m²) emerged as the only significant independent predictor of postoperative complications (AOR 2.12, p=0.03).

Conclusions VH offers clear short-term advantages over AH, including faster recovery and fewer immediate postoperative complications. Long-term outcomes, however, are broadly comparable between the two approaches. Elevated BMI significantly increases the risk of postoperative morbidity regardless of surgical route. These findings reinforce the importance of individualized surgical planning and preoperative optimisation to improve patient outcomes.