Complications of hysteroscopic surgery: predicting patients at risk.
OBJECTIVE
To determine the frequency of operative complications and whether they can be predicted by specific patient characteristics or type of hysteroscopic procedure.


METHODS
We collected demographic and medical history information on 925 women who had hysteroscopies from 1995 through 1996. We compared differences in rates of operative complications of specific hysteroscopic procedures. Operative complications were defined as uterine perforation, excessive glycine absorption (1 L or more), hyponatremia, hemorrhage (500 mL or more), bowel or bladder injury, inability to dilate the cervix, and procedure-related hospital admissions.


RESULTS
Operative complications occurred in 25 (2.7%) of 925 hysteroscopies. Excessive fluid absorption was the most frequent complication. Hysteroscopic myomectomy and resection of uterine septum were associated with greater odds of complications (odds ratio [OR] 7.4, 95% confidence interval [CI] 3.3, 16.6 and OR 4.0, 95% CI 0.9, 19.6, respectively). Hysteroscopic polypectomy and endometrial ablation were associated with lower odds of complications (OR 0.1, 95% CI 0.0, 0.7 and OR 0.4, 95% CI 0.1, 3.3, respectively). Hysteroscopies done by reproductive endocrinologists and preoperative GnRH agonist therapy were associated with 4-7 times higher odds for operative complications.


CONCLUSIONS
Complications during hysteroscopic surgery are rare. Among hysteroscopic procedures, myomectomies and resections of uterine septa have significantly higher rates of complications, especially excessive fluid absorption. Meticulous fluid management might limit the number of serious complications of these higher-risk procedures.
Propst
A M
AM
Department of Obstetrics, Gynecology and Reproductive Biology, the Division of Reproductive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. ampropst@bics.haravrd.edu
Liberman
R F
RF
Harlow
B L
BL
Ginsburg
E S
ES
D000328:Adult; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects*; D007431:Intraoperative Complications; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications; D012307:Risk Factors; D014599:Uterus / Q000601:surgery*