Trends in Morbidity Mortality Associated with Hysterectomy for Benign Gynaecological Disorders in Low Resource Settings

Background: Hysterectomy for benign gynaecological conditions is effective in relieving symptoms but ripple effects do occur. Hysterectomies are being performed for conditions where alternatives are available so there is a trend of more surgeries. Not much is known about India, but hysterectomy is very commonly performed. Aim: Study was carried out to know trends of morbidity, mortality with hysterectomy for benign gynaecological disorders in women of low resource settings. Methods: Study commenced in 1998. Retrospective records were collected and prospective cases were included till completion of 2 decades. Analysis of 4223case records of hysterectomies was done, at rural medical institute where most patients are rural. Overall 3985 (94.4%) hysterectomies were performed for benign gynaecological disorders (noncancerous tumours, inflammatory conditions, displacements, miscellaneous like adenomyosis, dysfunctional uterine hemorrhage). Analyses was done by dividing into four five yearly blocks A,B,C,D to know the trends. Results: Complications rate in abdominal hysterectomy was 19.39%, in Block A 26.42%, B 26.65%, C 18.72% and D 14.2%, 50% reduction in complications from recent past. Postoperative vaginal bleeding occurred in 1.18% in Block A, 0.37% in B, 0.52% in C and 0.7% in Block D. Wound infection rate decreased from 10.14% in Block A, 7.1% in D. Other complications had decreasing trend. In vaginal hysterectomy complications rate was 11.14%, 15% in Block A, 18.61% in B, 10.55% in C and 8.4% in D. Mortality was 0.1% (4 cases) 0.19% (one) in Block A, 0.14%(one) in B and 0.16% (2) in C and no mortality in Block D. Conclusion: Severe complications mortality can occur in hysterectomy for benign conditions also. Preoperative care, intraoperative care can reduce morbidities, mortalities, but not totally eliminate, even in present times. Keywords: Benign, disorders, gynaecological, hysterectomy, morbidity, mortality.