Profile of surgical complications in gynaecology at a teaching hospital in South Africa

Background. 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. Objective. To describe the cohort of patients undergoing gynaecological surgical procedures at Tygerberg Hospital, their complication rates and identify associated risk factors. Methods. We conducted a retrospective review of adult patients having emergency and elective gynaecological surgical procedures between 1 January and 31 December 2019. A total of 970 patients were included. We summarised categorical data as counts and percentages. We performed logistical regressions to assess factors associated with complications. Odds ratios (ORs) were reported as measures of association with the corresponding 95% confidence interval (CI). Statistical significance was set at a 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 indication for surgical intervention was benign gynaecological conditions (23.3%). Total abdominal hysterectomy was the single most common procedure performed (23.7%). Intraoperative or postoperative complications occurred in 12.7% of patients, while 1.2% sustained both intraoperative 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 with non-oncological surgery (OR 1.14; 95% CI 0.66 - 1.97; p=0.63). Conclusion. The provision of quality gynaecological care requires information on gynaecological surgical practices and patient outcomes. The rates of surgical complications at our facility appear to be higher than local and international studies, with our main contributors being infection-related complications and bowel injuries. An extended course of prophylactic antibiotics could be considered, as well as auditing infection control measures. Patients who are at a higher risk of bowel injury should be identified preoperatively and the surgery approached with care.