Early Emergency Visits After Laparoscopic Hysterectomy: Risk Factors and Prevention

Abstract

Objective:

This study evaluates emergency department (ED) visits within the first 30 days following hysterectomy for benign gynecologic conditions, identifying risk factors and strategies for prevention.

Methods:

A retrospective cohort analysis was conducted on 2,119 patients who underwent hysterectomy at a high-volume tertiary center between January 2023 and December 2024. Demographic, perioperative, and postoperative variables were analyzed, and predictors of ED visits were assessed using multivariable logistic regression.

Results:

ED visits occurred in 8.6% of patients, with older age, higher intraoperative blood loss, longer operative time, and prior abdominal surgery being significant predictors (P < .05). Vaginal cuff hematoma (29.7%) was the most common cause of hospitalization, whereas abdominal pain (39.3%) and nausea/vomiting (40.7%) were the most frequent nonhospitalized complaints. Minimally invasive techniques were associated with lower ED visit rates compared to total abdominal hysterectomy.

Conclusion:

Identifying high-risk patients and implementing structured postoperative monitoring may reduce unnecessary ED visits. Optimizing surgical techniques, perioperative management, and patient education is crucial for enhancing outcomes and reducing healthcare burden. Multicenter prospective studies are needed to validate these findings and refine perioperative strategies.

INTRODUCTION

A hysterectomy, the most common gynecological surgery, involves removing the uterus. Its prevalence among women is reported to range from 1.2% to 5.4%, depending on demographic, geographic, and healthcare system factors.^1,2 It is frequently performed to treat various benign gynecological conditions, such as fibroids, endometriosis, and abnormal uterine bleeding.³ However, like any surgical procedure, hysterectomy can lead to postoperative complications and increased healthcare use. Emergency department (ED) visits are common indicators of these complications and may highlight challenges patients face during the perioperative period.

Complications such as infection, bleeding, venous thromboembolism, urinary retention, and gastrointestinal dysfunction are among the most common reasons for postoperative ED visits. The literature shows that up to 4% of patients seek ED care within the first 30 days after hysterectomy, with a significant portion of these visits being preventable.⁴ According to a 2012 Canadian report, about 9% of women who had a hysterectomy for benign conditions sought emergency care after surgery. Of these visits, 20% were nonurgent cases that did not need follow-up, but it is important to remember that the remaining 80% were urgent cases requiring immediate medical attention, highlighting the importance of our roles in postoperative care.⁵

Identifying the factors that influence ED visits is crucial for improving patient care and reducing healthcare costs. Key factors include patient characteristics, surgical techniques, postoperative complications, and socioeconomic status.⁶ Preventing unnecessary ED visits can lessen the burden on the healthcare system and increase patient satisfaction.⁷ Therefore, recognizing high-risk groups and implementing personalized follow-up programs can enhance healthcare quality while decreasing economic costs. Compared to other surgical specialties, two studies in general surgery have reported that the rate of ED visits within 30 days after colon resection and appendectomy is approximately 8%.^8,9

This study aims to assess postoperative ED visits among patients who have undergone hysterectomy for benign gynecological conditions. By analyzing the frequency, causes, and related risk factors of these visits, it seeks to improve understanding of postoperative complications. Since there are few studies on this topic in the current literature, this research will offer a comprehensive analysis based on a large patient population.

METHODS

This retrospective cohort study assessed ED visits within the first 30 days after hysterectomy performed for benign gynecological reasons. It was carried out at a high-volume tertiary referral center specializing in minimally invasive gynecologic surgery. Data were collected over a two-year span, from January 1, 2023, to December 31, 2024. The study protocol received approval from the institutional ethics committee prior to data collection.

Study Population

A total of 2,119 patients who underwent hysterectomy for benign gynecological reasons were included in the study. The study group comprised patients who visited the ED within the first 30 days postoperatively, while the control group consisted of patients who did not require ED care during this period. Inclusion and Exclusion Criteria: Patients who underwent total laparoscopic hysterectomy (TLH), laparoscopic-assisted vaginal hysterectomy (LAVH), vaginal natural orifice transluminal endoscopic surgery (V-NOTES), or total abdominal hysterectomy (TAH) for benign conditions were included. Exclusion criteria included incomplete or ambiguous patient records, malignant pathology results, emergency visits unrelated to gynecological conditions, and readmissions for reasons unrelated to hysterectomy complications.

Patient data were retrospectively collected from the hospital’s electronic medical records and digital health databases after anonymization. Key variables analyzed included demographics (age, body mass index [BMI], comorbidities, smoking status, prior abdominal surgery), perioperative parameters (surgical technique, operative time, estimated blood loss, intraoperative complications, hospital length of stay), and postoperative outcomes (primary reasons for ED visits, hospitalization rate, and related risk factors). Estimated blood loss was calculated based on the difference between preoperative hemoglobin (measured 24 hours before surgery) and postoperative hemoglobin (measured 6 hours after surgery). Operative time was defined as the interval from the first incision to the final skin closure. The primary outcome was the timing and causes of ED visits within 30 days posthysterectomy. Secondary outcomes included factors influencing ED visits, hospitalization rates among ED patients, and predictors of unplanned postoperative hospital care. Throughout the study period, all patients were managed according to a standardized postoperative follow-up protocol implemented at our institution. Prior to discharge, patients received both verbal and written instructions regarding personal hygiene, wound care, and the recognition of potential postoperative complications. They were advised on situations requiring medical attention and informed about when to seek emergency care. Education on early warning signs of serious complications was also provided. All patients were scheduled for outpatient follow-up visits on postoperative days 10 and 30, which included a comprehensive clinical evaluation consisting of vaginal examination, transvaginal ultrasonography, and complete blood count (CBC) analysis.

Descriptive statistics were presented as mean ± standard deviation (SD) for normally distributed continuous variables and median with interquartile range (IQR) for non-normally distributed data. Categorical variables were analyzed using the χ² test or Fisher’s exact test, depending on sample size. For continuous variables, the Student’s t test or one-way analysis of variance (ANOVA) was used for normally distributed data. To identify independent predictors of ED visits, a multivariable logistic regression analysis was performed. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were reported for significant risk factors. A P-value of <.05 was considered statistically significant. All statistical analyses were conducted using SPSS Statistics version 27 (IBM Corp., Armonk, NY). The study was approved by the local Ethics Committee of SBÜ İzmir Tepecik Training and Research Hospital, and patient data were handled in accordance with ethical guidelines and institutional policies (Decision No: 2024/12–24).

RESULT

A total of 2,119 patients who underwent hysterectomy for benign reasons were included. Among them, 182 (8.6%) presented to the ED within the first 30 postoperative days. Patients who visited the ED tended to be older, had higher BMI, more comorbidities, longer operative times, greater intraoperative blood loss, and higher rates of intraoperative complications, especially bladder injury (all P ≤ .05). Smoking and a history of previous abdominal surgery were also more common among the ED group (P ≤ .05). No significant differences were observed between the groups regarding surgical approach or length of hospital stay. A χ² analysis comparing surgical techniques showed no statistically significant difference in ED visit rates (P = .269). Although cases requiring conversion had higher ED visit numbers, this difference was not statistically significant, as shown by the subgroup analysis in the crosstabulation table (Table 1). The most common causes of hospitalization among ED patients were cuff hematoma (29.7%), wound infection (18.9%), rectus hematoma (10.8%), and pelvic abscess (8.1%). Nonhospitalized patients more frequently presented with symptoms such as abdominal pain (40%), nausea and vomiting (40.7%), urinary tract infection (2.1%), and constipation (1.4%) (Table 2).

Table 1.

Comparison of Clinical and Demographic Characteristics Between ED and Non-ED Patients

	ED Visit n = 182, ±SD, (%)	No ED Visit n = 1,937, ±SD, (%)	P
Age	57.0829 ± 8.70177	53.9257 ± 9.4836	<.05
Parity	2.6961 ± 1.46872	2.9185 ± 1.49048	.055
BMI (kg/m2)	29.2768 ± 3.14286	28.7755 ± 3.16591	<.05
Smoking			<.05
Yes	127 (69.7%)	1171(60.4%)
No	55 (30.2%)	766 (39.6%)
Prior abdominal surgery			<.05
Yes	116 (63.7%)	677 (34.9%)
No	66 (36.2%)	1,260 (65.0%)
Operation time	58.1713 ± 31.98313	53.8787 ± 25.95547	<.05
Decrease in hemoglobin (mg/dl)	2.0888 ± 1.26896	1.4472 ± 0.82252	<.05
Specimen weight (g)	200.7901 ± 155.68101	215.5212 ± 232.67505	.81
Length of hospital stay (days)	1.4862 ± 1.15281	1.4659 ± 1.42987	.85
Surgical approach			.269
TLH	158a (86.8%)	1,694a (87.5%)
V-NOTES	4a (2.1%)	53a (2.7%)
TAH	9a (4.9%)	84a (4.3%)
VAH	5a (%2.8%)	57a (2.9%)
Robot	3a (1.7%)	42a (2.2%)
Conversion	3b (1.7%)	7a (0.4%)
Intraoperative complication			<.05
No complication	161 (89.0%)	1,929 (99.5%)
Bladder injury	13 (7.2%)	7 (0.4%)
Bowel injury	2 (1.1%)	1 (0.1%)
Hemorrhage	1(0.6%)	0
Ureter injury	4 (2.2%)	0
Comorbidity			<.05
No comorbidity	144 (79.1%)	1,760 (90.8%)
DM	15 (8.2%)	58 (2.9%)
HT	10 (5.4%)	49 (2.5%)
COPD	6 (3.2%)	35 (1.8%)
Thyroid	7 (3.8%)	35 (1.8%)

Table 2.

Association Between Emergency Department Admission Reasons and Hospitalization Status

Diagnosis/Condition	Hospitalization Required (n, %) N = 37	No Hospitalization (n, %) N = 145
Cuff hematoma	11 (29.7%)	2 (1.4%)
Wound infection	7 (18.9%)	0 (0.0%)
Bladder distension	1 (2.7%)	0 (0.0%)
Pelvic abscess	3 (8.1%)	0 (0.0%)
Rectus hematoma	4 (10.8%)	1 (0.7%)
Abdominal pain	4 (10.8%)	58 (40%)
Late ureteral injury	2 (5.4%)	0 (0.0%)
Urinary infection	2 (5.4%)	3 (2.1%)
Constipation	0 (0.0%)	2 (1.4%)
Nausea and vomiting	0 (0.0%)	59 (40.7%)
Vaginal spotting	3 (8.1%)	20 (13.8%)

Multivariable logistic regression identified the following independent predictors of ED visits: advanced age (OR: 1.036; 95% CI: 1.018–1.054; P ≤ .001), greater intraoperative blood loss (OR: 1.906; 95% CI: 1.649–2.202; P ≤ .001), longer operative time (OR: 1.006; 95% CI: 1.001–1.012; P = .028), and prior abdominal surgery (OR: 3.708; 95% CI: 2.651–5.187; P ≤ .001). Variables such as parity, BMI, uterine weight, smoking, and hospital stay were not significant in the multivariate model (Table 3).

Table 3.

Multivariable Logistic Regression Analysis of Factors Associated with Emergency Department Visits Within the First Month After Surgical Hysterectomy

Variable	Odds Ratio	95% CI	P-Value
Age	1.036	(1.018–1.054)	<.05
Parity	0.918	(0.818–1.031)	.147
BMI	1.043	(0.993–1.096)	.091
Blood loss	1.906	(1.649–2.202)	<.05
Operative time	1.006	(1.001–1.012)	.028
Uterine weight	1.001	(1.000–1.001)	.169
Hospital stay	1.011	(0.904–1.129)	.853
Smoking	1.338	(0.944–1.895)	.101
Previous abdominal surgery	3.708	(2.651–5.187)	<.05

Perioperative complications, surgical approach, and treatment modality were significantly associated with hospitalization rates among ED patients. Patients with bladder injury (27.02%), ureteral injury (10.81%), and bowel injury (5.4%) were more likely to be hospitalized (P ≤ .05). The choice of surgical approach also influenced hospitalization, with higher rates observed in TAH (18.9%), V-NOTES (10.8%), and conversion surgeries (5.4%) (Table 4). Antibiotics were administered in 70.3% of hospitalized cases, and all surgically treated patients required admission. Hospitalized patients had significantly higher uterine weights (312.5 ± 291.6 vs 187.4 ± 95.9 g, P ≤ .05) and shorter initial hospital stays (1.14 ± 0.35 vs 1.58 ± 1.26 days, P ≤ .05). No significant differences were found regarding age, BMI, blood loss, or operative time between hospitalized and nonhospitalized patients (Table 5).

Table 4.

Factors Influencing Hospitalization in Patients Presenting to the Emergency Department

Category	Diagnosis/Condition	Hospitalization Required (n, %) N = 37	No Hospitalization (n, %) N = 145	P-Value
Admission duration	<7 days	31 (83.78%)	100 (68.96%)	.073
	>7 days	6 (16.21%)	45 (31.03%)
Perioperative complication	None complication	21 (56.75%)	141 (97.24%)	<.05
	Bowel injury	2 (5.4%)	0 (0.0%)
	Hemorrhage	0 (0.0%)	1 (0.68%)
	Bladder injury	10 (27.02%)	3 (2.06%)
	Ureteral injury	4 (10.81%)	0 (0.0%)
Previous abdominal surgery	No	9 (24.3%)	57 (39.3%)	.091
	Yes	28 (75.7%)	88 (60.7%)
Surgical type	CONVERSION	2 (5.4%)	1 (0.7%)	<.05
	ROBOT	1 (2.7%)	2 (1.4%)
	TAH	7 (18.9%)	2 (1.4%)
	TLH	22 (59.5%)	136 (93.8%)
	V-NOTES	4 (10.8%)	0 (0.0%)
	VAH	1 (2.7%)	4 (2.8%)
Treatment	Antibiotics	26 (70.3%)	6 (4.1%)	<.05
	Surgical	5 (13.5%)	0 (0.0%)
	Symptomatic	6 (16.2%)	139 (95.9%)

Table 5.

Comparison of Clinical and Surgical Variables Between Hospitalized and Nonhospitalized Patients

Variable	Hospitalization Required (Mean ± SD)	No Hospitalization (Mean ± SD)	P-Value
Age	59.2 ± 8.14	56.4 ± 8.85	.06
BMI (kg/m2)	29.96 ± 3.40	29.08 ± 3.05	.13
Blood loss (mg/dl)	1.99 ± 1.16	2.10 ± 1.30	.60
Operative time (min)	62.05 ± 29.02	57.31 ± 32.65	.40
Uterine weight (g)	312.54 ± 291.62	187.44 ± 95.97	<.05
Hospital stay (day)	1.14 ± 0.35	1.58 ± 1.26	<.05

DISCUSSION

This analysis, conducted at one of Turkey’s largest centers specializing in minimally invasive hysterectomy, found that 8.5% (182/2119) of women who underwent hysterectomy for benign indications presented to the ED within 30 days postoperatively, although such visits rarely resulted in hospital readmission. The study also identified specific patient characteristics that were associated with an increased risk of ED visits. Recognizing these risk factors may support improvements in perioperative patient education and clinical management strategies. The growing utilization of EDs by elderly patients has become a significant concern for healthcare systems worldwide, primarily due to demographic shifts associated with population aging.¹⁰

The present study found that advanced age was significantly associated with ED visits within the first 30 days following hysterectomy (OR: 1.036; 95% CI: 1.018–1.054; P ≤ .05). Advanced age has also been linked to higher rates of postoperative complications and early mortality following abdominal surgery. As people get older, they are more susceptible to age-related immune system decline, delayed wound healing, and the presence of multiple comorbidities. These factors can contribute to an increased postoperative vulnerability.¹¹ Additionally, older adults often exhibit reduced symptom awareness, limited self-care capacity, and challenges in treatment adherence, which can delay the recognition of complications and lead to more frequent ED utilization.¹² Therefore, individualized discharge planning, timely outpatient follow-up, and enhanced perioperative monitoring represent key strategies to reduce ED visits and improve postoperative outcomes in elderly hysterectomy patients.

As obesity becomes increasingly prevalent, a growing number of obese women undergo hysterectomy each year. Although obesity is commonly considered a risk factor for postoperative complications following hysterectomy in clinical practice, its exact impact on complication rates remains uncertain, as current evidence presents inconsistent findings.^13–15 Clarifying the association between obesity and surgical complications could help gynecologic surgeons better counsel obese patients regarding the potential risks of hysterectomy. In our study, the mean BMI was significantly higher among patients who visited the ED after surgery, suggesting that elevated BMI may contribute to increased rates of postoperative emergency visits.

The long-term connection between smoking and the risk of cardiopulmonary diseases is well established.¹⁶ Smoking is recognized as an independent risk factor for adverse early perioperative outcomes across various surgical procedures. Surgical outcomes are affected by temporary disruptions to the tissue microenvironment, as well as the long-term impact on the functions of inflammatory and reparative cells.¹⁷ Notably, current smokers experience higher rates of respiratory and cardiovascular problems and have an increased risk of surgical site infections.¹⁷ Notably, current smokers exhibit higher rates of respiratory and cardiovascular complications and an increased risk of surgical site infections.¹⁸ However, in multivariable logistic regression analysis, smoking was not found to be a statistically significant predictor of ED visits within the first month after hysterectomy (OR: 1.338, 95% CI: 0.944–1.895, P = .101). Nonetheless, the OR greater than 1 suggests a possible trend toward an elevated risk of emergency visits among smokers compared to nonsmokers. Larger studies are warranted to further elucidate the impact of smoking on postoperative morbidity.

A history of previous abdominal surgery was significantly associated with a higher rate of ED visits (P < .05), likely due to intra-abdominal adhesions and postoperative pain. Additionally, prior surgery (OR: 3.708, 95% CI: 2.651–5.187, P < .001) was the strongest predictor of ED visits, possibly reflecting increased adhesions, altered pelvic anatomy, or increased surgical complexity. These findings emphasize the importance of targeted postoperative monitoring and patient education, especially in high-risk populations, to reduce unnecessary ED visits and support recovery. Similarly, previous studies have reported an increased risk of postoperative complications in patients with a prior abdominal surgery.¹⁸ The operative time was significantly longer for patients presenting to the ED (P < .05). Longer operative time (OR: 1.006, 95% CI: 1.001–1.012, P = .028) was another key factor, possibly indicating more complex procedures or intraoperative challenges that contributed to postoperative complications. It is well known that extended surgical durations can cause increased intraoperative tissue damage, which may lead to postoperative pain and hinder the recovery process.¹⁹ Additionally, the decrease in hemoglobin levels was significantly larger in the ED group (P < .05). Multivariable logistic regression revealed significant associations with ED visits within the first month after hysterectomy. Likewise, increased blood loss during surgery (OR: 1.906, 95% CI: 1.649–2.202, P < .05) was strongly associated with ED visits, indicating that intraoperative hemorrhage may contribute to complications such as anemia, delayed healing, or secondary bleeding episodes.

When examining the relationship between the timing of ED visits and hospitalization, it was observed that, although not statistically significant (P = .073), 83.78% (n = 31/37) of hospitalized patients presented to the ED within the first 7 postoperative days. Additionally, patients who experienced perioperative complications were significantly more likely to visit the ED within this early postoperative period. Evaluation of the association between surgical method and hospitalization requirements revealed that conversion cases and TAH were associated with notably higher hospitalization rates. In contrast, minimally invasive surgical techniques correlated with shorter recovery times and lower ED visit rates, consistent with existing literature.²⁰ These findings support the idea that minimally invasive surgery might speed up recovery after surgery, which could lower the number of visits to the ED and hospital stays.

This study found that the most common reason for hospitalization among patients visiting the ED after hysterectomy was vaginal cuff hematoma (29.7%), followed by wound infections (18.9%) and rectus hematoma (10.8%). These complications usually require clinical monitoring due to bleeding, infection, and pain. Vaginal cuff hematoma was identified as the main cause of ED visits after hysterectomy. The estimated incidence of infected hematomas ranges between 6% and 9%.²¹ The development of vaginal cuff hematomas is influenced by various factors, including the surgical technique used, inadequate hemostasis, patient comorbidities, the colpotomy method, and the type of hysterectomy performed.²² In most cases, these hematomas respond well to antibiotic therapy. However, when there is no response to antibiotics and the hematoma does not show spontaneous regression during follow-up, vaginal drainage is preferred as the treatment approach. Importantly, no cases in our study required reoperation due to vaginal cuff hematoma. We specifically highlight two cases of late ureteral injury that required emergency admission. A continuous watery discharge from the vagina, occurring between 7 and 21 days postoperatively, is a characteristic sign of ureterovaginal fistula (UVF).²⁴ Beyond the first week after surgery, difficulty urinating, clear serous vaginal discharge, and pelvic ectasia should be considered in emergency situations.

In contrast, the most common reasons for emergency visits—abdominal pain (39.31%) and nausea with vomiting (40.68%)—were mostly treated without hospitalization. Conditions requiring the least hospitalization included constipation (1.37%), globus vesicalis (2.9%), and urinary tract infections (5.7%), which were generally resolved through outpatient care. Clinically, conditions associated with bleeding and infection more frequently required hospitalization, whereas functional or mild symptoms were managed on an outpatient basis. Preoperative education programs, health optimization strategies tailored to specific surgical groups, and structured postoperative nursing support, including telephone follow-ups, have proven effective in improving clinical outcomes and reducing healthcare costs.²³

The literature indicates that higher uterine weight increases the risk of postoperative complications, particularly when the uterine weight exceeds 500 grams.²⁴ Similarly, in our study, uterine weights were significantly higher in patients requiring hospitalization, suggesting that larger uterine size may lead to greater postoperative risk. Previous studies have shown that same-day discharge after minimally invasive hysterectomy does not increase complication rates and may even lower hospital readmissions.²⁵ However, our findings revealed that patients with shorter initial hospital stays had higher subsequent hospitalization rates. This inconsistency could be due to differences in discharge decisions based on individual patient characteristics or early signs of complications. Therefore, careful evaluation of patient risk factors and clear discharge criteria are essential to ensure the safety of early discharge after minimally invasive hysterectomy.

Reducing unnecessary ED visits after hysterectomy requires a proactive, multifaceted approach that addresses both clinical and patient-centered factors. Structured preoperative counseling plays a pivotal role in preparing patients by informing them about typical postoperative symptoms, warning signs that require urgent care, and appropriate self-care measures. This should be complemented by enhanced discharge instructions, including clear, accessible printed or digital materials that guide patients on when to seek emergency care. For high-risk individuals—such as those with elevated BMI, prior abdominal surgeries, or prolonged operative times—early scheduled follow-up visits within the first week postoperatively can help detect complications before they escalate. In addition, telephone or telemedicine support offers patients real-time access to professional guidance, which can reduce unnecessary ED visits driven by anxiety or uncertainty. Lastly, targeted risk mitigation strategies, including extended postoperative observation or intensive monitoring for select patients, may further prevent complications that would otherwise result in emergency presentations. Together, these interventions can improve patient outcomes, optimize resource utilization, and reduce the burden on emergency services.

This study has several limitations. As a single-center, retrospective analysis, the generalizability of the findings may be limited in clinical settings with different patient populations, surgical practices, or follow-up protocols. Although a standardized follow-up protocol was implemented, individual factors—such as patient adherence to postoperative recommendations or access to healthcare services—could not be fully accounted for. Moreover, as the study included only patients who underwent hysterectomy for benign gynecologic conditions, the findings may not be applicable to those with malignant pathologies. Multicenter, prospective studies are warranted to validate these results in more diverse populations and clinical environments.

One of the major strengths of this study is that it was conducted at a high-volume tertiary referral center specialized in minimally invasive gynecologic surgery and is based on a large, well-defined patient cohort. This allowed for a comprehensive evaluation of early postoperative ED visits following hysterectomy for benign indications, with detailed analysis of both the frequency and underlying causes of such visits. By examining the associations between patient characteristics and perioperative factors, the study demonstrated that advanced age, a history of prior abdominal surgery, prolonged operative time, and increased intraoperative blood loss were significant contributors to the risk of ED utilization. While some ED visits were related to mild symptoms that did not require clinical intervention, those resulting in hospitalization were generally associated with well-defined complications such as infection, hematoma, or organ injury. These findings highlight the need for tailored management approaches based on the nature of the presenting complaint and contribute to the improvement of postoperative care pathways.

CONCLUSION

This study provides a comprehensive analysis of ED visits occurring within 30 days following hysterectomy for benign gynecologic conditions. Our findings highlight key predictors of unplanned postoperative care, including advanced patient age, increased intraoperative blood loss, prolonged surgical duration, and a history of prior abdominal surgery. The most frequent cause of hospital readmission was vaginal cuff hematoma, whereas milder symptoms such as abdominal pain and nausea were predominantly managed on an outpatient basis. Understanding why patients seek emergency care after hysterectomy is essential for improving outcomes and reducing healthcare burdens. In this context, our results underscore the importance of enhancing perioperative strategies. Preventive measures should include meticulous surgical technique, effective intraoperative hemostasis, comprehensive preoperative counseling, and structured postoperative follow-up, especially for high-risk individuals. Providing patients with clear expectations about common postoperative symptoms and guidance on when to seek medical attention can also help reduce unnecessary ED visits. Future multicenter prospective studies are warranted to validate these findings and develop targeted interventions aimed at minimizing preventable complications and optimizing postoperative care pathways after hysterectomy.