A 30 days’ postoperative complications after Gynecologic surgery at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A Retrospective cohort study
DOI:
https://doi.org/10.69614/ejrh.v17i2.866Keywords:
postoperative complication, Gynecologic surgeries, OncologyAbstract
Background: Postoperative complications are defined as any deviation from the normal postoperative course (1). The incidence of these complications after elective surgery in low- and middle-income countries is estimated at 11% (2). However, studies show that the 30-day postoperative complication rate following gynecologic surgery can vary significantly, ranging from 0.2% to 26% (3,4,5,6). To date, no studies have specifically examined postoperative complication rates following Gynecologic Oncology surgery in Ethiopia. This retrospective study aims to investigate postoperative complications to enhance patient care.
Objectives: To assess 30-day postoperative complications following gynecologic surgery at Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia, in 2024 G.C.
Methods: We conducted a retrospective cohort study examining 30-day postoperative complications among gynecologic surgical patients over three years, from January 2021 to December 2023 G.C. After obtaining ethical clearance from the Departmental Research and Publication Committee (DRPC), we compared categorical variables using the chi-square test. Both binary and multiple logistic regressions were performed to identify associated factors, with significance set at P < 0.05 and a 95% confidence interval (CI).
Results: A total of 355 patients who underwent gynecologic surgery were analyzed during the study period. Of these, 118 patients were presumed to have benign conditions, while 237 were diagnosed with malignancies preoperatively. Patients undergoing surgeries for oncological indications were significantly older, with a median age of 48 years (IQR 40-60), compared to a median age of 37 years (IQR 30-45) for benign cases. The overall postoperative complication rate was 31%, with 41% of histopathology-confirmed malignant patients experiencing complications, compared to 19.6% of confirmed benign cases. The most common complication among benign surgical patients was surgical site infection (SSI), while intraoperative or postoperative blood transfusion was the primary complication for malignant patients, followed by SSI. Overall, 16% (58/355) of patients required intraoperative transfusions, with rates of 8.3% in benign cases and 23.5% in oncologic cases. Postoperative readmission rates were 2.4% for benign cases and 6.4% for malignant cases, with SSI being the leading cause of readmission. Multivariable analysis identified that being underweight (AOR 3.829, 95% CI 1.396-10.506), overweight (AOR 1.731, 95% CI 1.019-2.941), and a postoperative diagnosis of malignancy (AOR 3.234, 95% CI 1.958-5.343) were significantly associated with complications.
Conclusion: This study demonstrates that postoperative complications are not uncommon following gynecologic oncologic surgeries, with a mortality rate of 1.6% among confirmed malignant cases. The most frequent complication in malignant cases was intraoperative or postoperative blood transfusion, and the postoperative readmission rate was nearly threefold higher in malignant cases compared to benign cases. This comprehensive data on complications can inform future benchmarking of surgical practices.
References
Reference
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004 Aug;240(2):205-13. doi: 10.1097/01.sla.0000133083.54934.ae. PMID: 15273542; PMCID: PMC1360123.
International Surgical Outcomes Study group. Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries. Br J Anaesth. 2016 Oct 31;117(5):601-609. doi: 10.1093/bja/aew316. Erratum in: Br J Anaesth. 2017 Sep 1;119(3):553. doi: 10.1093/bja/aew472. PMID: 27799174; PMCID: PMC5091334.
Ikram A. et al, Postoperative Complications After Gynecologic Surgery, EJUA-BA, vol 4, 2023. DOI:10.1097/AOG.0b013e31822dac5d
Kaya AC, Radosa MP, Zimmermann JSM, Stotz L, Findeklee S, Hamza A, Sklavounos P, Takacs FZ, Wagenpfeil G, Radosa CG, Solomayer EF, Radosa JC. Intraoperative and postoperative complications of gynecological laparoscopic interventions: incidence and risk factors. Arch Gynecol Obstet. 2021 Nov;304(5):1259-1269. doi: 10.1007/s00404-021-06192-7. Epub 2021 Aug 21. PMID: 34417837; PMCID: PMC8490211.
Busque A-A, Belzile E, Rodrigues J, Larouche M. Major Perioperative Complications of Benign Gynecologic Procedures at a University-Affiliated Hospital. McGill J Med [Internet]. 2022 Oct. 23 [cited 2024 Aug. 14];21(1). Available from: https://mjm.mcgill.ca/article/view/960
Xu M, Zhang W, Gao C, Zhou Y, Xie Y. Postoperative pulmonary complications and outcomes in cytoreductive surgery for ovarian cancer: a propensity-matched analysis. BMC Anesthesiol. 2022 Apr 23;22(1):120. doi: 10.1186/s12871-022-01660-2. PMID: 35461230; PMCID: PMC9034613.
Erekson EA, Yip SO, Ciarleglio MM, Fried TR. Postoperative complications after gynecologic surgery. Obstet Gynecol. 2011 Oct;118(4):785-93. doi: 10.1097/AOG.0b013e31822dac5d. PMID: 21934441; PMCID: PMC3178335.
Wallace SK, Fazzari MJ, Chen H, Cliby WA, Chalas E. Outcomes and Postoperative Complications After Hysterectomies Performed for Benign Compared With Malignant Indications. Obstet Gynecol. 2016 Sep;128(3):467-475. doi: 10.1097/AOG.0000000000001591. PMID: 27500339.
Bahadur A, Mundhra R, Kashibhatla J, Chawla L, Ajmani M, Sharma S, Zaman R, Sri MS. Intraoperative and Postoperative Complications in Gynaecological Surgery: A Retrospective Analysis. Cureus. 2021 May 7;13(5):e14885. doi: 10.7759/cureus.14885. PMID: 34104610; PMCID: PMC8180178.
Thomasson, J., Schött, U., & Bansch, P. (2017). 30-Day Postoperative Outcome in Patients Undergoing Extensive Gynaecological Surgery. EC Gynaecology, 4(3), 113-123. https://www.ecronicon.com/ecgy/pdf/ECGY-04-00094.pdf
Iyer R, Gentry-Maharaj A, Nordin A, Burnell M, Liston R, Manchanda R, Das N, Desai R, Gornall R, Beardmore-Gray A, Nevin J, Hillaby K, Leeson S, Linder A, Lopes A, Meechan D, Mould T, Varkey S, Olaitan A, Rufford B, Ryan A, Shanbhag S, Thackeray A, Wood N, Reynolds K, Menon U. Predictors of complications in gynaecological oncological surgery: a prospective multicentre study (UKGOSOC-UK gynaecological oncology surgical outcomes and complications). Br J Cancer. 2015 Feb 3;112(3):475-84. doi: 10.1038/bjc.2014.630. Epub 2014 Dec 23. PMID: 25535730; PMCID: PMC4453652.
Cory L, Latif N, Brensinger C, Zhang X, Giuntoli RL 2nd, Burger RA, Morgan M, Ko E. Readmission After Gynecologic Surgery: A Comparison of Procedures for Benign and Malignant Indications. Obstet Gynecol. 2017 Aug;130(2):285-295. doi: 10.1097/AOG.0000000000002141. PMID: 28697106.
Cory, Lori A. MD; Latif, Nawar MD; Zhang, Xiaochen MPH; Giuntoli, Robert MD; Morgan, Mark MD; Ko, Emily MD. Post-Surgical Readmissions Among Women Undergoing Benign and Malignant Gynecologic Surgery [17]. Obstetrics & Gynecology 127():p 6S, May 2016. | DOI: 10.1097/01.AOG.0000483633.51771.52
Uppal S, Penn C, Del Carmen MG, Rauh-Hain JA, Reynolds RK, Rice LW. Readmissions after major gynecologic oncology surgery. Gynecol Oncol. 2016 May;141(2):287-292. doi: 10.1016/j.ygyno.2016.02.031. Epub 2016 Mar 12. PMID: 26927757.
Pyrzak A, Saiz A, Polan RM, Barber EL. Risk factors for potentially avoidable readmissions following gynecologic oncology surgery. Gynecol Oncol. 2020 Oct;159(1):195-200. doi: 10.1016/j.ygyno.2020.07.103. Epub 2020 Aug 6. PMID: 32771277.
Wilbur MB, Mannschreck DB, Angarita AM, Matsuno RK, Tanner EJ, Stone RL, Levinson KL, Temkin SM, Makary MA, Leung CA, Deutschendorf A, Pronovost PJ, Brown A, Fader AN. Unplanned 30-day hospital readmission as a quality measure in gynecologic oncology. Gynecol Oncol. 2016 Dec;143(3):604-610. doi: 10.1016/j.ygyno.2016.09.020. Epub 2016 Sep 21. PMID: 27665313.
Gaym A. Elective hysterectomy at Tikur Anbessa Teaching Hospital, Addis Ababa. Ethiop Med J. 2002 Jul;40(3):217-26. PMID: 12602245.
F. Siddiqua, S. Y. Moni, N. B. Doty, and M. Khanum, "A study of Complications and Outcome of Major Gynaecological Operations-Analysis of 100 Cases," KYAMC Journal, vol. 5, no. 1, pp. 444-448, 2017
N. C. Lambrou, J. L. Buller, J. R. Thompson, G. W. Cundiff, B. Chou, and F. J. Montz, "Prevalence of perioperative complications among women undergoing reconstructive pelvic surgery," American journal of obstetrics and gynecology, vol. 183, no. 6, pp. 1355-1360, 2000.
Thomasson, J., Schött, U., & Bansch, P. (2017). 30-Day Postoperative Outcome in Patients ndergoing Extensive Gynaecological Surgery. EC Gynaecology, 4(3), 113- 23. https://www.ecronicon.com/ecgy/pdf/ECGY-04-00094.pdf
Kuusela K, Norppa N, Auranen A, Saarelainen S. Maximal surgical effort increases the risk of postoperative complications in the treatment of advanced ovarian cancer. Eur J Surg Oncol. 2022 Dec;48(12):2525-2530. doi: 10.1016/j.ejso.2022.06.007. Epub 2022 Jun 9. PMID: 35717320.
Swift BE, Maeda A, Bouchard-Fortier G. Adverse postoperative outcomes associated with perioperative blood transfusion in gynecologic oncology surgery. Int J Gynecol Cancer. 2023 Apr 3;33(4):585-591. doi: 10.1136/ijgc-2022-004228. PMID: 36792167.
Mark J, Lynam S, Morrell K, Eng K, Starbuck K, Szender JB, Zsiros E, Frederick PJ. Implementation of a restrictive blood transfusion protocol in a gynecologic oncology service. Gynecol Reprod Endocrinol. 2019;3(1):1-5. doi: 10.35841/2591-7994.3.1-5. PMID: 32550597; PMCID: PMC7299237.
Wallace SK, Halverson JW, Jankowski CJ, DeJong SR, Weaver AL, Weinhold MR, Borah BJ, Moriarty JP, Cliby WA, Kor DJ, Higgins AA, Otto HA, Dowdy SC, Bakkum-Gamez JN. Optimizing Blood Transfusion Practices Through Bundled Intervention Implementation in Patients With Gynecologic Cancer Undergoing Laparotomy. Obstet Gynecol. 2018 May;131(5):891-898. doi: 10.1097/AOG.0000000000002463. PMID: 29630007; PMCID: PMC5912961.
AlDardeir N, Alzhrani G, Alqutub A, Kabli R, Sait D, Alsaeed R, Alruwaithi S, Algarni A, Sawan D. Rates and Causes of Readmission Within 60 Days Following Hysterectomy in a Tertiary Care Center in Saudi Arabia. Cureus. 2023 Mar 22;15(3):e36500. doi: 10.7759/cureus.36500. PMID: 37090381; PMCID: PMC10121272.
Morell A, Samborski A, Williams D, Anderson E, Kittel J, Thevenet-Morrison K, Wilbur M. Calculating surgical readmission rates in gynecologic oncology: The impact of patient factors. Gynecol Oncol. 2023 May;172:115-120. doi: 10.1016/j.ygyno.2023.03.015. Epub 2023 Apr 5. PMID: 37027939.
Gynecologic surgery in the obese woman. Committee Opinion No. 619. American College of Obstetricians and Gynecologists. Obstet Gynecol 2015;125:274–8,2015
Thomas EJ, Goldman L, Mangione CM, Marcantonio ER, Cook EF, Ludwig L, Sugarbaker D, Poss R, Donaldson M, Lee TH. Body mass index as a correlate of postoperative complications and resource utilization. Am J Med. 1997 Mar;102(3):277-83. doi: 10.1016/S0002-9343(96)00451-2. PMID: 9217597.
