A study on postoperative complications following major obstetrics and gynaecological surgeries

 

 

Abstract               Background: Any surgical procedure carries risks of complications. The risk of postoperative complications depends on individual characteristics, including: age, medical comorbidities, and functional status. They need to be reduced because they contribute to morbidity and mortality. Adverse events that are closely related to processes of care, such as postoperative complications, may be a better measure of quality than death rates or other intermediate out comes (1).Aim of The Study: To study incidence of post operative complications and surgical care following major obstetric and gynaecological surgeries. Objectives: 1. To know different types of post operative complications following major obstetric and gynaecological surgeries.2. To know the relative incidence of such post operative complication.3To Study factors that are associated with post operative complications such as obesity, blood loss and duration of surgery (more than or less than 02hours)Materials And Method: An observational study was conducted at Owaisi Hospital and Princess Esra hospital in the Department of Obstetrics and Gynecology from August 2016 to January 2018. The study included all the patients undergoing major surgeries for either obstetric or gynaecological indication. Results: The study focused on the post operative complications following major obstetric and gynaecological surgeries. The following are the complications observed in the present study. Overall the post operative complications observed are very low. 8.6% of total cases showed febrile morbidity, the highest recorded complication. Vault hemorrhage was 4.4% (4 of 84 patients of hysterectomy) followed by lap surgery converted to open surgery (2.3% of 129 lap surgeries). Surgical site infections are expected to be high in any surgeries but in the present study only 1.6% of the cases had developed this complication. Blood transfusion and blood loss more than 1000ml was in 1.8% of the cases. Urinary retention after open surgery and laparoscopic surgery occurred in 1.7% and 4.6%, respectively. Conclusion: The incidence of post operative complications can be reduced by 1.Proper selection of the patient2.Pre-operative evaluation of the patient3.Improve nutritional status and hygiene of the patient prior to surgery.4.Intra operatively - maintain sterility, good surgical technique, reducing blood loss and strict vigilance of unavoidable complications.5.Post operatively-adequate analgesia, fulfillment of hydration, antibiotics, starting drugs for co-morbid conditions and monitoring of patient for development of any complications.

Key Word: surgical procedure.

 

 

 

INTRODUCTION

Any surgical procedure carries risks of complications. The risk of postoperative complications depends on individual characteristics, including: age, medical comorbidities, and functional status. They need to be reduced because they contribute to morbidity and mortality. Adverse events that are closely related to processes of care, such as postoperative complications, may be a better measure of quality than death rates or other intermediate out comes ⁽¹⁾. With preoperative evaluation, meticulous technique, and vigilance for impending problems, intra operative and early postoperative complications are largely preventable.The keys to reduce the morbidity due to post operative complications are suspicion, anticipation, early recognition and prompt appropriate intervention.These complications are not only distressing to the patients and care providers but can also impose an economic burden on hospital. It is necessary to know the incidence of each of the post operative complications, so as to standardize the assessment and prompt management, such that high quality care can be administered.

 

OBJECTIVES OF THE STUDY

1. To know different types of post operative complications following major obstetric and gynaecological surgeries.
2. To know the relative incidence of such post operative complication.
3. To Study factors that are associated with post operative complications such as obesity, blood loss and duration of surgery (more than or less than 02hours)

 

MATERIALS AND METHOD

An observational study was conducted at Owaisi Hospital and Princess Esra hospital in the Department of Obstetrics and Gynecology form august 2016 to january2018 The study included all the patients undergoing major surgeries for either obstetric or gynaecological indication.

Method of collection of data

Inclusion Criteria

The study will included all the patients admitted in obstetrics and gynaecology ward, who underwent major surgery on elective or emergency basis.

Exclusion Criteria

Minor procedures were excluded from the study. The following procedures in obstetric and gynaecology were excluded from this study.

Obstetrics

1. Dilatation and Evacuation
2. Cervical Encerclage
3. Amniocentesis
4. Amnioinfusion /Amnioreduction
5. Induction of Labour
6. Versions (External and Internal)
7. Operative Vaginal Delivery
8. Episiotomy and Lower Genital Tract Injuries
9. Manual Removal of Placenta

Gynaecology

1. Diagnostic Hysteroscopy
2. Endometrial Aspiration / DandC
3. Tests of Ovulation and Tubal Patency
4. Intrauterine Insemination
5. Visual Inspection with Acetic Acid (VIA) and Colposcopy
6. Cervical Biopsy
7. Minor Operations on the Cervix

All cases were followed up post operatively during the period of hospital stay.

 

RESULTS
The study concentrated on the post operative complication following major obstetric and gynaecological surgeries. The study is intended to identify the primary reason for such complications which are distressful to patient and increase liability on hospitals. The study would result in finding possible factors/measures that would minimize the post-operative complications. Among the total 500 major surgery, 355 were abdominal surgeries, 129 were laparoscopic and 16 were vaginal surgeries. These surgeries were broadly classified into obstetric (261, all are Cesarean section) and gynaecological surgeries (239). The most common obstetrical and open gynaecological surgery were cesarean section and total abdominal hysterectomy, respectively

 

Table 1: Obstetric surgery- Cesarean section

 

Table 2: Various gynaecological surgeries

Complications observed in the study The study focused on the post operative complications following major obstetric and gynaecological surgeries. The following are the complications observed in the present study. (Table 2).

Table 2: Percent observed post-operative complication following obstetric and gynaecological surgeries.(n= 500)

A retrospective analysis of observations during the study was carried out. Various clinical parameters like age of patient, blood pressure, hemoglobin content, kind of surgery, post-operative complications, time taken for completion of surgery, days of hospital stay etc. were recorded systematically. These parameters have great relevance in clinical research. Most of these parameters are highly correlated with each other. The statistical procedure in the present study, chi-square analysis, tests the association between parameters and gives degree of association. Following are the results of the chi-square analysis done between important parameters.

 

Table 2a: Association between Post-Operative Complications and Haemoglobin percentage

* Indicates significant at 5% confidence limit

The number of patients with Hemoglobin levels lower than 10 gm % were very less as pre-operatively anemia was corrected in all elective cases.

Table 2c: Association between Post-operative complications and BMI

* Indicates confidence interval significant at 1%

The two parameters, BMI and postoperative complications are significantly associated with each other (Table 2c). The present study clearly states that patients with BMI more than 30kg/sq m are likely to develop Surgical site infections

Table 2d: Association between blood loss and operation time

*Indicates significant at 1% confidence interval

A positive association exists between blood loss during operation and duration of surgery (Table 2d). As the duration increases there is high probability of more blood loss and it stands true.

 

Table 2e: Association between post-operative complications and operation time

* Indicates significant at 5% confidence interval

Post operative complications are likely to be high as the duration of surgery increases (Table 2e). This explains complex surgery require more time and are associated with more complications. The duration of anaesthesia is more. Complications due to prolonged exposure of peritoneal contents to outside environment and probabilities of contamination increases. There is requirement of extra doses of antibiotics as the surgery time increases by 02 hours.

 

Table 2f: Association between Hospital stay and post-operative complications

 *Indicates significant at 1% confidence interval

The statistical analysis shows high probability that post operative complications increases days of hospital stay. The correlation values are high suggesting that the days of hospital stay is an indicator of the complexity of post- operative complication.

 

Table 2g: Association analysis of age with surgery

Age and surgery are highly associated traits. It is found and is obvious that women under 30 years of age undergo maximum surgeries. Cesarean section and surgeries for contraception are the most common surgeries done among this age group. It signifies that this age is the most active reproductive age.