A profile of surgical complications in gynaecology at a teaching hospital in South Africa
Date
2022-11
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Stellenbosch : Stellenbosch University
Abstract
ENGLISH ABSTRACT: Background and Aim
Information about current gynaecological surgical practices and patient outcomes is integral to the
provision of quality gynaecological care. An audit of surgical complications can provide important
information needed for an assessment of current surgical practices and outcomes. The aim of the study
was to describe the cohort of patients having gynaecological surgical procedures at Tygerberg Hospital,
their complication rates and identify associated risk factors.
Method
We conducted a retrospective review of patients, 18 years and older, having emergency and elective
gynaecological surgical procedures between 01 January 2019 and 31 December 2019. Nine hundred and
seventy patients were included. We summarised categorical data as counts and percentages. We
performed bivariate and multivariate logistical regression to assess clinical and surgical factors
associated with complications. We reported odds ratios as a measure of association with the
corresponding 95% confidence interval. Statistical significance was set at p-value <0.1 and p-value <
0.05 in the bivariate and multivariate analysis, respectively.
Results
Overweight and obese patients accounted for 60% of patients. The most common indications for surgical
intervention were early pregnancy complications (22.2%), benign gynaecological conditions (23.3%)
and gynaecological malignancy (19.2%). Total abdominal hysterectomy was the single most common
procedure performed and accounted for 23.7% of surgical procedures. Intra-operative or post-operative
complications occurred in 12.7% of patients, while 1.2% sustained both intra-operative and postoperative
complications. The most common complications were infection-related (7.5%) and bowel
injury (1.8%). Oncological surgery did not increase the likelihood of complications compared to nononcological
surgery (OR 1.14; CI 0.66-1.97 p-value 0.63). Intra-operative blood loss of more than 500ml
was associated with an increase in complications.
Conclusion
The provision of quality gynaecological care requires information on gynaecological surgical practices
and patient outcomes. These outcomes should be comparable to both national and international
standards. The rates of surgical complications at our facility appear to be higher than local and
international studies, with our main contributors being infective-related complications and bowel
injuries. The use of on an extended course of prophylactic antibiotics could be considered, as well as
auditing infection control measures. Those at a higher risk of bowel injury should be identified preoperatively
and the surgery approached with care.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar.
Description
Thesis (MMed) -- Stellenbosch University, 2022.
Keywords
Generative organs, Female -- Surgery -- South Africa, Hysterectomy -- Complications -- South Africa, Women's hospitals -- South Africa, UCTD