Morbidity and Mortality Associated With Abdominal Hysterectomy

Objective: This study was done to determine morbidity and mortality associated with abdominal hysterectomy. Study Design: This is an observational study. Duration and Setting: This study was started in June 2017 and completed in December 2017, comprising on 7 months duration. Study was conducted in Chaudhary Akram Teaching Hospital Lahore, Pkistan. Patients and Methods: Total 96 patients were included in this study which were operated for abdominal hysterectomy in the hospital during given period of seven months. These cases were admitted in the Gynaecology and obstetrics ward due to various causes such as DUB, leomyoma uterine and endometrial hyperplasia etc. These patients were admitted in the ward on OPD bases. Proper investigations and preoperative workup was done. Anesthesia fitness was taken. Cardiology opinion was also taken in ladies above 45 years for any cardiac problem. CBC, serum profile, chest x-ray, PT, INR, ECG were done. These patients were planned for abdominal hysterectomy. Most of them underwent total hysterectomy while few had sub-total hysterectomy. Consent was also taken from the incharge of ward for conducting study. Proper history was taken from all paytients, physical examination done and findings were documented as well. All data was analyzed in Microsoft office version 2007 and SPSS software. Results were calculated in the form of frequencies and they were presented as tables, charts and graphs. Results: There were 96 cases in the study. Age of patients was in the range of 30-55 years with mean age of 46.7 years. Most of the cases were having age above 40 years. There were 13(13.5%) with age 30-35 years, 20(20.8%) cases 36-40 years, 25(26.1%) having age 41-45 years, 28(29.2%) cases with age 46-50 years and 10 cases were in age group above 50 years. There were various causes of hysterectomy out of which dysfunctional uterine bleeding was most common in 38(39.6%), leomyoma uterine in 20(20.8%), endometrial hyperplasia in 9(9.3%), adenomyosis in 14(14.6%), Pelvic tumor or ovarian cyst in 7(7.3%) and endometriosis was found cause in 3(3.1%) cases. After operation patients were retained in the ward and full monitoring was done. Complications were observed and documented. In 5(5.2%) cases intra-operative hemorrhage occurred, bladder injury in 2(2.1%), ureteric injury happened in 1 case, perforation of bowel occurred in 3(3.12%), post operative hematoma formation in 2(2.1%), enterocutaneous fistula in 2(2.1%), DVT formation in one case and relaprotomy was done in one case. Total abdominal hysterectomy was done in 90(93.7%) and subtotal hysterectomy was done in 6(6.3%) cases.  Conclusion: Abdominal hysterectomy is associated with high rate of complications. Intraoperative hemorrhage is most common complication. Most common cause of hysterectomy was DUB. Complications were higher in old age females.