The Incidence of Obstetrics and Gynecology Cases Returning to Operation Theater due to Postoperative Complications in a Tertiary Care Hospital

Abstract

Introduction: Unexpected return to operation theater carries high rate of morbidity and mortality for patients, in addition to increased hospital stay. A close look at such cases would help in identifying high-risk patients thus improving outcome. The aim of the study was to evaluate the incidence of Obs/Gyn cases returning to OT due to postoperative complications in a tertiary care hospital. Methods: It was a retrospective observational study done at tertiary care hospital settings affiliated with academic center in the UAE. The records of patients were scrutinized, and all booked and non-booked pregnant patients of any age undergoing emergency or elective obstetrics or gynecological procedure from January 1, 2016 to December 31, 2020 were enrolled in the study. Relaparotomy was defined as cases opened within same admission and causally associated with previous primary obstetrics or gynecological operation. Result: A total of 21,276 operations were performed from 2016 to 2020. In these 4 years, 33 patients had unexpected return to operation theater making the incidence of re-exploration to 0.15% (33/21,276). There were 16 (48.48%) emergency operations and 17 (51.52%) elective operations previously done on these patients. The most common primary procedure for which re-exploration was done was lower segment caesarean section done in 11 (33.3%) of cases followed by laparoscopic adhesiolysis and myomectomy. Hematoma in the pelvic region and ooze from raw area were the most common per-operative finding in 48.48% of cases. There was no mortality in the abovementioned cases; however, 2 (6.06%) had early acute kidney injury and both recovered from it. Discussion: The incidence of relaparotomy in our hospital is comparable to international literature. Most patients returned to OT within 48 h. Bleeding was the most common indication for laparotomy, and lower segment cesarean section was most common primary operation. This study underscores the need for meticulous hemostasis before closing to avoid return to OT. Conclusion: Return to OT for the right indication saves life. Mortality in such cases may be reduced by earlier detection and treatment of postoperative problems, consideration of relaparotomy, active ICU monitoring, and postoperative care.