Predictors of hysterectomy during myomectomy: a retrospective cohort study

Abstract

This study aimed to determine the risk of unplanned hysterectomy during myomectomy and identify factors associated with this risk. A total of 1,368 patients who underwent myomectomy at four hospitals in Osmaniye Province, Türkiye, between January 2014 and December 2025 were retrospectively analyzed. The study included three secondary-care hospitals and one tertiary referral hospital. The primary outcome was defined as unplanned hysterectomy performed due to complications occurring during myomectomy or in the early postoperative period. Categorical variables were compared using Fisher’s exact test, and continuous variables were compared using the Mann-Whitney U test. Due to the rarity of the event, Firth’s penalized likelihood logistic regression method was used to identify independent risk factors. Unplanned hysterectomy was performed in 18 (1.3%) of the 1,368 patients who underwent myomectomy. In multivariable analysis, smoking, comorbidities, and larger myoma size were associated with higher odds of hysterectomy; however, some estimates were imprecise, as reflected by wide confidence intervals, particularly for smoking (OR = 25.32, 95% CI: 5.42–128.9) and comorbidity (OR = 10.20, 95% CI: 2.83–44.60). Each 1-kg/m² increase in body mass index was found to reduce the risk of hysterectomy (OR = 0.81, 95% CI: 0.71–0.93, p =.002). Age (OR = 1.06, 95% CI: 1.00-1.13, p =.065) remained at the threshold of statistical significance. Postoperative complications were significantly higher in the hysterectomy group (61.1% vs. 1.9%, p <.001). Unplanned hysterectomy during myomectomy was observed in 1.3% of cases. Smoking, the presence of comorbidities, and larger myoma size were associated with higher odds of hysterectomy in this cohort. Given the small number of hysterectomy events and the wide confidence intervals of some estimates, these findings should be interpreted cautiously and considered hypothesis-generating pending confirmation in larger studies.