Abstract
BackgroundHysterectomy is one of the most common gynaecological procedures performed worldwide. The magnitude of the complications related to hysterectomy and their risk factors are bound to differ based on locations, availability of resources and level of surgical training. Documented complications rates and their correlates are reported from high income countries while data from low- and middle-income countries including Tanzania is scare.MethodsThis was a hospital based cross-sectional study conducted at a tertiary facility in northern Tanzania where 178 women who underwent elective gynecological hysterectomies in the department of obstetrics and gynecology within the study period were enrolled. Logistic regression was performed to determine the association between risk factors and occurrence of surgical complication where p-value of < 0.05 was considered statistically significant. The degree of correlation between pre-operative clinical and histological diagnosis was determined by kappa correlation test.ResultsA total of 75 (42%) of women had surgical complications within 10 days of surgery. Blood transfusion and intra-operative bleeding were the most common complications observed in 34 (19.1%) and 17 (9.6%) women respectively. Independent risk factors for complications included obesity (OR 3.9; 95% CI 1.44–10.46), previous abdominal operations (OR 8.44; 95% CI 2.52–28.26) and longer duration of operation (> 2 h) (OR 5.02; 95% CI 2.18–11.5). Both uterine fibroid and adenomyosis had good correlation of clinical and histological diagnosis (p-value < 0.001).ConclusionBleeding and blood transfusion were the most common complications observed in this study. Obesity, previous abdominal operation and prolonged duration of operation were the most significant risk factors for the complications. Local tailored interventions to reduce surgical complications of hysterectomy are thus pivotal. Clinicians in this locality should have resources at their disposal to enhance definitive diagnosis attainment before surgical interventions.
Highlights
Hysterectomy is one of the most common gynaecological procedures performed worldwide
Study setting This study was conducted at Kilimanjaro Christian Medical Center (KCMC) referral and tertiary hospital located in Kilimanjaro region in northern Tanzania
Study most common surgical complications observed were blood transfusion and prolonged hospital stays, this findings was similar with the findings which was observed in Nigeria and Ghana respectively [3, 4]
Summary
Hysterectomy is one of the most common gynaecological procedures performed worldwide. The magnitude of the complications related to hysterectomy and their risk factors are bound to differ based on locations, availability of resources and level of surgical training. Incidence of gynecological hysterectomy varies between countries. USA and Germany have reported 600,000 and 34,872 hysterectomies annually respectively [1, 2]. Kano hospital in Nigeria reported a hysterectomy rate of 5.1% [3], and in Korle Bu teaching hospital in Ghana it was found to be 7.8% [4]. Indications for gynecological hysterectomy include uterine fibroid, adenomyosis, intraepithelial neoplasm (CIN), prophylaxis against uterine cancer, endometrial adenocarcinoma e.t.c [5,6,7]. As with all kinds of surgery, hysterectomy can have complications as well. Some of the reported complications include hemorrhage, urinary tract injury, surgical site wound infection, fever, blood transfusions, reoperation, organ lesions and re hospitalizations [8, 9]
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