What is the mortality rate for non-emergent hysterectomy (non-emergency surgical removal of the uterus)?

From the Guidelines

The mortality rate for non-emergent hysterectomy is very low, approximately 0.06% to 0.2% (or about 1-2 deaths per 1,000 procedures). This makes hysterectomy a relatively safe surgical procedure when performed in a planned, non-emergency setting. The risk varies slightly depending on the surgical approach, with minimally invasive techniques like vaginal and laparoscopic hysterectomies generally having lower mortality rates compared to open abdominal procedures 1. Patient-specific factors that can increase mortality risk include advanced age, obesity, smoking, diabetes, cardiovascular disease, and other pre-existing medical conditions. The cause of death in these rare cases is typically related to surgical complications such as infection, bleeding, thromboembolism, or anesthetic complications.

Key Considerations

• The least invasive route for hysterectomy should be performed, as abdominal hysterectomy is associated with longer hospital stay, recovery time, and greater pain and risk of infection compared to other approaches 1.
• Vaginal hysterectomy is associated with shorter operating times, a faster return to normal activities, and a better quality of life compared to abdominal hysterectomy 1.
• Laparoscopic hysterectomy is associated with a faster return to normal activities, shorter hospital stays, and lower rates of wound infection compared to abdominal hysterectomy 1.
• Modern surgical techniques, improved anesthesia protocols, and enhanced perioperative care have contributed to the continued reduction in mortality rates for hysterectomy over recent decades.

Recommendations

• Patients considering hysterectomy should discuss their individual risk factors with their healthcare provider during pre-operative consultations.
• Hysterectomy should be avoided if a less invasive procedure is available, as randomized studies have demonstrated increased rate of severe complications, longer hospitalization, and a longer return to regular activities with hysterectomy compared to UAE despite similar symptom relief 1.
• Cohort studies and registries have reported long-term effects of hysterectomy, including increased risk of cardiovascular disease, osteoporosis and bone fracture, and dementia 1.

From the Research

Mortality Rate for Non-Emergent Hysterectomy

• The mortality rate for non-emergent hysterectomy is not directly stated in the provided studies, but study 2 examines the association between hysterectomy for benign indications and all-cause mortality.
• According to study 2, hysterectomy without oophorectomy before 35 years of age is associated with an increase in all-cause mortality (hazard ratio, 1.29; 95% confidence interval, 1.19-1.40).
• Study 2 also found that hysterectomy with bilateral salpingo-oophorectomy before 45 years of age is associated with increased all-cause mortality (35-44 years: hazard ratio, 1.15; 95% confidence interval, 1.04-1.27).
• However, studies 3, 4, 5, and 6 focus on the prevention of surgical site infections after hysterectomy and do not provide direct information on mortality rates.

Surgical Site Infection Rates

• Study 4 reports an overall rate of surgical site infection of 1.8% (n=329) after hysterectomy, with a lower rate of 1.4% (n=13) for patients who received cefazolin plus metronidazole.
• Study 6 found that surgical site infections occurred in 14% (12/83) of surgeries with cefotetan versus 8.2% (6/73) with cefazolin plus metronidazole for prophylaxis (p = 0.19).
• These studies suggest that the choice of antibiotic prophylaxis may impact the rate of surgical site infections after hysterectomy, but do not provide direct information on mortality rates.