A STUDY ON EVALUATION OF VARIOUS FACTORS LEADING TO HYSTERECTOMIES IN A TERITIARY CARE CENTRE

Abstract

Background: Hysterectomy is a common surgical procedure performed to treat various gynecological conditions such as uterine fibroids, abnormal uterine bleeding, pelvic organ prolapse and cancers.^[1] In tertiary care centers, where patients with complex cases are often referred, understanding the indications and other alternatives available prior to hysterectomy is crucial for optimizing patient care.^[2] Factors such as patient education, treatment compliance, and socioeconomic status play an important role in determining the mode of treatment. However, medical therapies are often inadequate, which leads many patients to ultimately opt for surgery.^[3] This study aims to explore the various profiles of patients undergoing abdominal hysterectomies in a tertiary care setting to better understand the clinical outcomes and factors influencing treatment decisions.

Aims and objectives: To identify various indications and risk factors for Hysterectomies in various gynaecological conditions.

Methods: A retrospective study was conducted on patients who underwent hysterectomy at a tertiary care center over a two-year period. The study included data on patient demographics, indications for surgery, alternative treatments used prior to hysterectomy, preoperative d & c, surgical techniques (abdominal, vaginal, or laparoscopic), intraoperative complications, and postoperative recovery.

Results: In this retrospective study of 152 case records of patients underwent hysterectomy at a tertiary care center, the majority were in the 41-55 years age group (62%), with fibroid uterus (35.53%) being the most common indication, followed by adenomyosis (11.84%) and abnormal uterine bleeding (AUB) (10.53%). The most frequent symptom was menstrual disturbances (61.2%), and the majority of procedures were abdominal (90.8%). Hormonal treatment was used in 50.4% of patients prior to surgery, and most patients had symptoms lasting 6-12 months (36.2%). Hypertension (26.3%) was the most common comorbidity, followed by hypothyroidism (15%). Histopathological findings revealed leiomyoma (36.1%) as the most prevalent pathology, with combined leiomyoma and adenomyosis occurring in 17.2%. The most common postoperative complications were wound infections (7.9%) and urinary tract infections (6.6%).

Conclusion: This study provides a comprehensive overview of the factors associated with hysterectomies in a tertiary care center. The findings are in line with those of previous studies, highlighting that fibroids remain the leading indication for hysterectomy, followed by adenomyosis and abnormal uterine bleeding. The study also highlights the significant role of comorbidities in the patient population and the high utilization of hormonal therapies prior to surgery. Postoperative complications were generally low, with the most common being wound infections and UTIs. Further research with larger cohorts and long-term follow-up is needed to evaluate the long-term outcomes and complications associated with hysterectomy, particularly in patients with significant comorbidities.