Hysterectomy for benign conditions in a tertiary care centre: a clinical audit

Abstract

Background: This clinical audit is to determine the indications, type, and outcome of hysterectomy performed for benign gynaecological conditions in two years and to identify the problem or issue (if any) in planning the hysterectomy for benign conditions.

Methods: The present study is a hospital-based prospective study conducted in the Department of Obstetrics and Gynaecology, Narayana Medical College and Hospital, a tertiary care centre, Nellore, AP. Six hundred women, who underwent the hysterectomy during the study period are recruited into this study after obtaining hospital ethical committee approval and informed consent. Among the total of 50,450 women attended our OPD for gynaecological complaints, 600 patients underwent the hysterectomy. Thus 9.6% of total gynaecological admissions ended up with the hysterectomy.

Results: The mean age group of the study is 49.07±8.0 years. Majority of women belonged to low socio-economic status. Predominant age group underwent hysterectomy was 40-49 years. Majority (78.2%; 469 cases) of hysterectomies were done in multiparous women. Chief complaints were menstrual irregularities. Abnormal uterine bleeding -leomyoma (AUB-L) (228 cases; 38%) was the most common indication for hysterectomy. Most commonly done procedure was total abdominal hysterectomy TAH (60.5%; 363 cases). 306 cases (51%) had oophorectomy  (beyond the age of 45 years).The various complications (hemorrhage, sepsis etc..) found to happen mainly in hysterectomies done through abdominal route. 95% of hysterectomised histopathological specimen’s histopathology reports correlated with the pre-operative biopsy reports.

Conclusions: In proved benign conditions, women were counselled and encouraged for medical and conservative methods. Hysterectomies should be decided in those situations where the above measures fail and also where it was found to be the definitive management in the first instance. Woman’s option has also to be considered in certain cases. The route of hysterectomy has to be decided case to case basis and choice of the attending clinician. Oophorectomy was decided in the premenopausal women depending on the condition of the ovaries witnessed at the time of surgery.