title: An audit of indications and complications associated with elective hysterectomy at a public service hospital in South Africa.
abstract: OBJECTIVE
  To assess relationships between clinical indication for hysterectomy and postoperative histologic findings, and to audit complications of hysterectomy at the gynecologic surgical unit of a public-service hospital in South Africa.
  
  
  METHODS
  Surgical indications and details, histologic findings, and postoperative course were reviewed and analyzed for 335 patients who underwent hysterectomy at Groote Schuur Hospital, Cape Town, South Africa, in 2007.
  
  
  RESULTS
  Hysterectomy was performed abdominally in 265 patients (79.1%) and vaginally in 70 (20.9%) patients (5 of these procedures were laparoscopically assisted). The most common indication was fibroid-related menorrhagia (23%), followed by abnormal uterine bleeding (14.9%). The incidence of intraoperative complications was 6-fold greater among patients with malignant disease than among those with a benign condition (P=0.001). The incidence of postoperative complications was greater following abdominal rather than vaginal surgery, whether traditional or laparoscopic (P=0.02).
  
  
  CONCLUSIONS
  Most hysterectomies were carried out abdominally rather than vaginally, in part because many patients presented with advanced cancer or other condition that warranted this approach. Because of resource constraints, patients with benign conditions were more likely to be offered surgery if they had a clearly defined condition.
authors.affiliation: Department of Obstetrics and Gynecology, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa. jbutt@sun.ac.za
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Butt
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Jeffery
authors.forename: Zephne M
authors.initials: ZM
authors.lastname: Van der Spuy
mesh_terms: D000328:Adult; D000368:Aged; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000379:methods; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D007045:Hysterectomy, Vaginal / Q000009:adverse effects / Q000379:methods*; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods; D008485:Medical Audit / Q000706:statistics & numerical data; D008595:Menorrhagia / Q000209:etiology / Q000601:surgery; D008875:Middle Aged; D009369:Neoplasms / Q000473:pathology; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013019:South Africa; D014592:Uterine Hemorrhage / Q000601:surgery