ABDOMINAL HYSTERECTOMY OR ABDOMINAL MYOMECTOMY FOR SYMPTOMATIC LEIOMYOMA - A COMPARISON OF PREOPERATIVE DEMOGRAPHY AND POSTOPERATIVE MORBIDITY

This retrospective study directly compared the morbidities associated with abdominal hysterectomy and abdominal myomectomy for the treatment of symptomatic leiomyomas in premenopausal women. Medical records of consecutive inpatients with a discharge diagnosis of leiomyoma who underwent operative therapy from July 1990 through June 1991 were reviewed. A total of 313 patients met inclusion criteria and were available for analysis. Women undergoing hysterectomy (n = 204) were older (42.8 +/- 0.3 vs 35.8 +/- 0.5 years, mean +/- SEM, p < 0.0001) and had greater mean gravidity (1.9 +/- 0.1 vs 0.7 +/- 0.1, p < 0.0001) and parity (1.4 +/- 0.1 vs 0.3 +/- 0.1, p < 0.0001) than women undergoing myomectomy (n = 109). Preoperative indications, symptoms, and preoperative uterine size were comparable between groups. There was no difference between the groups in the mean length of the procedure, the proportion of patients receiving blood transfusions, or the mean length of hospital stay. Women undergoing hysterectomy had a greater mean estimated blood loss than women undergoing myomectomy (438 +/- 24 vs 315 +/- 25 mL, p < 0.01). Estimated blood loss was correlated positively with uterine size for women undergoing either hysterectomy (r = 0.14, p < 0.01) or myomectomy (r = 0.27, p < 0.01), the number of myomas resected for patients undergoing myomectomy (r = 0.28, p < 0.005), and length of procedure for patients undergoing hysterectomy (r = 0.64, p < 0.0001) or myomectomy (r = 0.47, p < 0.0001). Febrile morbidity was more common in women undergoing myomectomy than in those having hysterectomy (45% vs 25.%, p < 0.0001), despite an equal proportion of patients receiving preoperative antibiotics, but myomectomy patients were no more likely to have an identified source of infection or longer hospital stay.