Hysterectomy Complications: Five Year Long Experience of a Tertiary Health Center

Objective: This study aims to analyze the experience of a tertiary health center about the complications of hysterectomy within a period of five years. Methods: This is a retrospective review of 1311 hysterectomies which were performed for both benign and malignant indications between 1 January 2017 and 1 January 2023. Results: Complications occurred in 218 patients (16.6%) and the mortality rate was 0.5% (n=6). The rate of conversion into laparotomy was 2.8%. Bladder injury, colon injury, ileus and incisional hernia were significantly more frequent in women who underwent laparotomy (p=0.007, p=0.026, p=0.027 and p=0.010 respectively). Wound infection and the need for transfusion were also significantly more common in the laparotomy group (p=0.001 for both). Logistic regression analysis indicated hysterectomy technique as an independent prognostic factor for its complications (p=0.001). Ureter injury, bladder injury and colon injury were significantly less frequent in patients who had hysterectomy for gynecological malignancy (p=0.001, p=0.001 and p=0.015 respectively). Massive bleeding, need for transfusion and wound infection were also significantly less frequent in patients who were hysterectomized for malignancy (p=0.001 for all). Hospital stay was significantly longer in patients undergoing hysterectomy for laparotomy and gynecological malignancy (p=0.001 for both). Conclusion: Minimally invasive techniques such as laparoscopy or vaginal approach should be attempted whenever it is possible and feasible. Performing hysterectomy for benign pathologies should not be considered as a distraction from meticulous work during the preoperative preparation and postoperative monitorization periods. Similar attention should be also paid to patients who have chronic diseases.