Factors influencing vaginal cuff dehiscence after laparoscopic hysterectomy and the psychological state of the patients

Table 1 Baseline data of the patients, n (%)/mean ± SD

Characteristic	Patients (n = 1459)
Age (years old)	50.70 ± 6.39
BMI (kg/m2)	23.73 ± 3.24
Menopausal	411 (28.2)
Disease type
Uterine fibroids	756
Adenomyosis	265
Adenomyosis combined with uterine fibroids	66
Cervical intraepithelial neoplasia grade III and carcinoma in situ	230
Mixed endometriosis	28
Benign ovarian tumor	32
Atypical hyperplasia of endometrium	80
Placental site trophoblastic tumor	2

BMI: Body mass index.

Table 2 Relevant data of 9 patients

Case	Disease	Preoperative hemoglobin value (g/L)	Review 1 month after surgery	Clinical symptoms	Vaginal cuff rupture time after surgery (days)	Reason	Treat
1	Uterine fibroids	118	-	Vaginal bleeding	15	Infect	Conservative treatment
2	Uterine fibroids	115	-	Asymptomatic	24	Infect	Conservative treatment
3	Uterine fibroids	145	-	Asymptomatic	30	Sex	Transvaginal repair
4	Adenomyosis	68	Basic healed	Vaginal bleeding	48	Infect and sex	Transvaginal repair
5	Uterine fibroids	82	Basic healed	Vaginal bleeding	55	Infect and sex	Transvaginal repair
6	Cervical intraepithelial neoplasia	125	Fully healed	Asymptomatic	75	Sex	Exploratory laparotomy
7	Adenomyosis	80	Fully healed	Asymptomatic	98	Sex	Exploratory laparotomy
8	Uterine fibroids	78	Fully healed	Asymptomatic	102	Sex	Transvaginal repair
9	Cervical intraepithelial neoplasia	133	-	Vaginal bleeding	130	Infect	Conservative treatment

Table 3 Single factor analysis of vaginal stump dehiscence after laparoscopic hysterectomy

Univariate logistic regression analysis	OR (95%CI)	P values
Age (< 50/≥ 50)	2.20 (0.55-8.82)	0.267
BMI (< 25 kg/m2/≥ 25 kg/m2)	1.72 (0.36-8.32)	0.499
Menopause (No/Yes)	3.17 (0.40-25.38)	0.278
Reason for surgery (uterine leiomyoma/adenomyosis/adenomyosis with uterine leiomyoma/cervical high-grade intraepithelial neoplasia/endometriosis/benign ovarian tumor/atypical endometrial hyperplasia/placental site trophoblastic tumor)	1.16 (0.74-1.82)	0.516
Comorbidities (hypertension/diabetes/hypertension with diabetes/hyperthyroidism/cholecystitis, gallstones/without)	0.74 (0.39-1.43)	0.373
Operation time (< 120/≥ 120)	1.08 (0.27-4.34)	0.912
Preoperative hemoglobin (g/L) (< 90/≥ 90)	5.12 (1.36-19.23)	0.016
Suture method (interrupted suture/continuous suture)	0.26 (0.70-0.99)	0.048
Postoperative hemoglobin (g/L) (< 90/≥ 90)	2.38 (0.59-9.57)	0.223
Postoperative body temperature (< 38 °C/≥ 38 °C)	0.37 (1.00-1.38)	0.138
Sexuality (without/< 3 months/≥ 3 months)	15.86 (2.83-88.97)	0.002

BMI: Body mass index.

Table 4 Multivariate logistic regression analysis of vaginal stump dehiscence after laparoscopic hysterectomy

Multivariate logistic regression analysis	OR (95%CI)	P values
Preoperative hemoglobin (g/L) (< 90/≥ 90)	5.17 (1.37-19.49)	0.015
Suture method (interrupted suture/continuous suture)	0.26 (0.70-0.98)	0.052
Sexuality (< 3 months/≥ 3 months)	54.00 (3.59-811.35)	0.004

Table 5 Psychological resilience of patients, mean ± SD

Items	Number	Total (n = 1459)	With vaginal stump dehiscence (n = 9)	Without vaginal stump dehiscence (n = 1450)	t value	P value
CD-RISC	1459	61.71 ± 6.10	58.33 ± 9.42	61.73 ± 6.07	1.669	0.095
Strength	1459	21.06 ± 3.16	20.89 ± 5.30	21.06 ± 3.14	0.161	0.872
Optimism	1459	9.55 ± 1.37	10.00 ± 1.12	9.55 ± 1.37	0.983	0.326
Resilience	1459	31.11 ± 5.07	31.89 ± 4.31	31.10 ± 5.07	0.466	0.641
SCSQ	1459
Positive coping	1417	10.59 ± 3.51	-	-	-	-
Negative coping	42	-2.86 ± 1.96	-	-	-	-

SCSQ: Simplified Coping Style Questionnaire; CD-RISC: Connor–Davidson Resilience Scale.