Gayatri Anipindi1

The complications following major gynaecological surgery are distressing and impose economic burden on the patients. Literature available sponsored by World Health Organization suggests that more than 234.2 (95%, CI 187.2-281.2) million major surgical procedures are undertaken every year worldwide. However, the outcome following surgery is a significant public health issue. In view of the high complication rates of major surgical procedures, surgical safety has now become a global public health concern. Surgical procedures have major physical, psychological and social impacts on patients and consume significant resources. Hence, there is a need to establish surveillance of surgical procedures and pre and postoperative practices that can influence the outcome. Standardised protocols are required for assessment and prompt management of the condition by knowing the incidence of each postoperative complication. This study was mainly undertaken to study the postoperative morbidity and their implications in a group of patients who had undergone major gynaecological surgeries.
A prospective observational study was conducted in the Department of Obstetrics and Gynaecology of Andhra Medical College/King George Hospital, Visakhapatnam, from January 2015 to December 2015. A total of 100 women who had undergone major gynaecological surgery and satisfied the inclusion criteria were included as study samples. Postoperative follow up of patients was conducted till the patients were discharged from the hospital. Preoperative, intraoperative and postoperative details of the case were recorded in a structured pro forma for statistical analysis.
In this study, majority of the women who had undergone the major gynaecological surgery belonged to 41-50 years of age group. Spinal anaesthesia was used in more than half of the cases in this study. Fibroid uterus was the major indication for surgery followed by AUB refractory to medical management, primary infertility, ovarian cysts and AUB with second-degree uterovaginal prolapse. More than quarter of subjects in this study had undergone vaginal hysterectomy followed by total abdominal hysterectomy, total abdominal hysterectomy with salpingo-oophorectomy, diagnostic laparoscopy and vaginal hysterectomy with anterior colporrhaphy. The time of surgery was 61-120 minutes in 52.5% of the patients in this study. The blood loss was less than 100 mL in 67.5% of the study subjects. Postoperative morbidity was not present in 71.7% of the study subjects. The rate of blood transfusion was 10.0% and 6.7% had febrile morbidity, 3.3% had surgical site infection, 2.5% had urinary retention, 1.7% had bladder injury, UTI and vault haemorrhage and 0.8% had bowel injury and conversion of laparoscopy to open surgery.
This study had shown that most of the cases belonged to age group of more than 30 years and uterine pathology are common indications for gynaecological surgeries. The main postoperative morbidity included blood transfusion and febrile morbidity.