Journal of Medical Society

ORIGINAL ARTICLE
Year
: 2015  |  Volume : 29  |  Issue : 1  |  Page : 4--7

Trend of hysterectomy: A retrospective analysis in Regional Institute of Medical Sciences (RIMS)


Rashmi Bala, Khumanthem Pratima Devi, Chanam Manglem Singh 
 Department of Obstetrics and Gynecology, Regional Institute of Medical Sciences, Imphal, Manipur, India

Correspondence Address:
Dr. Khumanthem Pratima Devi
Registrar, Department of Obstetrics and Gynecology, Regional Institute of Medical Sciences, Imphal - 795 004, Manipur
India

Abstract

Background: Hysterectomy is the second most common operation done in women next only to cesarean delivery. Trend of hysterectomy has changed over times with development of newer ideas, techniques, etc. An attempt has been made to study it and to assess the current scenario. Aims: To review and analyze cases of hysterectomy with a view to suggest ways of improving health care. Materials and Methods: A retrospective study was conducted from January 2007 to August 2011 which included 1,285 cases of hysterectomy. Parameters like age, parity, indication, procedure were analyzed and data was presented in percentages and proportions. To avoid biased result, emergency and routine cases were analyzed separately. Result: Most women were of more than 45 years of age in planned cases and between 20 to 45 years in emergency cases. Uterine fibroid was the commonest indication (40.7%). Obstetrical complications were the main cause for emergency hysterectomies. The most common procedure was total abdominal hysterectomy but in emergencies, subtotal hysterectomy was the procedure of choice. The rate of vaginal hysterectomy was 10.7%. Ovaries were preserved in 12.7%. Conclusion: Hysterectomy is usually postponed till 45 yrs of age in planned cases. Uterine myoma is the most common pathology in planned procedure. In emergency, the indication varies. Abdominal route is still the preferred by most gynecologists. The rates of vaginal hysterectomy and preservation of ovaries are much lower than desired.



How to cite this article:
Bala R, Devi KP, Singh CM. Trend of hysterectomy: A retrospective analysis in Regional Institute of Medical Sciences (RIMS).J Med Soc 2015;29:4-7


How to cite this URL:
Bala R, Devi KP, Singh CM. Trend of hysterectomy: A retrospective analysis in Regional Institute of Medical Sciences (RIMS). J Med Soc [serial online] 2015 [cited 2019 Nov 21 ];29:4-7
Available from: http://www.jmedsoc.org/text.asp?2015/29/1/4/158917


Full Text

 INTRODUCTION



World over hysterectomy is the most common surgery in women next only to cesarean section. There is a large variation in the rate of hysterectomy in different parts of the world. It may be due to physician factor, patient factor or organizational factor like availability of alternative resources. In India, only extrapolated figures are available based on international data base 2004. According to this, out of 1,065,070,607 women, 2,310,263 have had hysterectomy (2.16/1,000 women). The rate of hysterectomy in India seems to be on the rise. The common indication of hysterectomy are fibroid uterus, dysfunctional uterine bleeding (DUB), prolapsed genital organ, genital malignancy, etc. using a variety of techniques and approaches including abdominal, vaginal, and laparoscopy. Considerable attention has been directed to the rate of concurrent oopherectomy with this procedure. This rate is of particular concern in premenopausal women because of the early menopause that ensues. The complication of post hysterectomy has also decreased with the advent of new techniques, antibiotics, patient, and doctor awareness, etc.

In response to the consistent demand for this procedure, recent reports have identified hysterectomy as A key health indicator used to measure and compare hospital performances. The present study makes an attempt to analyze the trend of hysterectomy over past four and half years in a tertiary care center.

 Materials and Methods



This is a retrospective study done from January 2007 to August 2011 in the department of obstetrics and gynecology, Regional Institute of Medical Sciences (RIMS), Imphal. Hysterectomy done as routine (n = 1,236) and as emergency (n = 49) were analyzed separately to avoid any biased result and then compared. Data collected was analyzed using descriptive statistics based on the parameters of age, parity, indication, procedure done, oopherectomy done or not, and presented in percentages and proportion.

 RESULTS



As shown in [Table 1], majority of patients were of age 45 years or more when hysterectomy was done as a planned procedure; and when done in emergency set-up, the predominant age-group was from 21 to 44 years. From [Table 2], it could be seen that maximum patients were of parity 1-3 in both emergency and routine set-up. Both the tables on analysis were found to be statistically significant.{Table 1}{Table 2}

In routine set-up, hysterectomy was mainly done for gynecological indication and in emergency, it was mainly done for obstetric indication. [Table 3] shows the distribution of gynecological indications. Symptomatic uterine fibroid was the most common indication for routine cases. Gynecological pathology was a rare indication for hysterectomy in emergency and in this group, bleeding uterine fibroid was the most common indication. [Table 4] analyses the obstetric indications. Atonic post partum hemorrhage, post vaginal delivery, or post cesarean was the most common reason for a woman to land in emergency hysterectomy. Routine cases had a lower percentage of obstetric hysterectomy, cervical ectopic being the major cause.{Table 3}{Table 4}

In [Table 5], distribution of different types of hysterectomies which were done in our center over the past four and half years have been described. Overall, total abdominal hysterectomy was the most common procedure. However, subtotal hysterectomy was the commonly opted procedure in time of emergency. Vaginal hysterectomy rate came to be around 8.6%. In [Table 6], it is demonstrated that one or both ovaries were preserved in 20% of patients in age-group 21-44 years and 5% in age-group 45-59 years in abdominal hysterectomy cases. Findings were statistically significant in both these tables.{Table 5}{Table 6}

 DISCUSSION



Hysterectomy is a commonly done operation worldwide in women. The frequency of hysterectomy is quite high in other parts of the world (10-20%) as compared to India where it is roughly 4-6%, though the rate has been increasing in an alarming rate in recent years. [1] About 75% of all hysterectomies are done between the ages of 20-49 years. [2] In present study, in planned procedures, most patients were 45 years or above but in emergency hysterectomy they were mostly between 21-44 years of age. Also, most of the women had 1-3 children. Almost 60% of gynecological operation was hysterectomy. Of all the patients undergoing emergency operation, only 0.4% landed in hysterectomy.

Indication in 75.2% of women in our study was for benign pathology. In USA, 91.7% hysterectomy are for benign causes. [3] In our study, the main indication was symptomatic uterine fibroid (34%) followed by DUB. In another study, commonest indication was fibroid (26%) followed by DUB in a study. [4] In emergency, most common indication was atonic post-partum hemorrhage. Najam R [5] reported the most common indication of doing emergency hysterectomy as rupture uterus was 75% (in our study it was only 2%) followed by atonic post-partum hemorrhage (16.6%). Hysterectomy can be done via abdominal, vaginal, or laparoscopy route. Abdominal route is associated with longer hospital stay, increased complication, and higher cost. But due to the practice of style, training habits, and performance of gynecologists, most of them still continue to use abdominal approach. Since vaginal hysterectomy carries less risk and complications, this route is encouraged especially if disease is confined to the uterus and uterine weight is less than 280 gram. In UK and USA, 60-80% of the hysterectomies are done by abdominal route. In our study, 91.4% of the hysterectomy was done by abdominal route and 8.6% were done by vaginal route. The rate of abdominal hysterectomy was 83.4% and vaginal hysterectomy was 10.7% in another study done by Aksu et al.[6] The rate of subtotal hysterectomy in the above-mentioned study was only 0.7%. In our study, the rate of subtotal hysterectomy in planned procedure was 8.4%.

The merit of doing a concurrent oopherectomy during hysterectomy continues to be debated for women not at a high risk for developing ovarian cancer. Estimates regarding the number of prophylactic oopherectomies needed to prevent one case of ovarian cancer range from 200 to 300. The benefits such as prevention of ovarian cancer and perhaps breast cancer have to be weighed against an instant surgical menopause that may increase the woman's risk of ischemic heart disease and osteoporosis. Both ovaries were removed in 87.3% of abdominal hysterectomy in our study as opposed to another study. [7]

 CONCLUSION



The trend of hysterectomy is on a rise nowadays. There is a tendency to delay hysterectomy if possible till 45 years of age. Uterine myoma still remains the most common cause in India, as well as in the world, except in emergency where the indication varies which may be due to the variation in available health care facilities, expertise etc. Abdominal route is the preferred route, with a tendency to remove the uterus along with the cervix in a planned surgery. But in emergency, subtotal hysterectomy is being opted more and more. The rate of doing vaginal hysterectomy is lower than expected. Ovaries are preserved in lesser number of cases when compared to USA or UK.

References

1Singh A, Arora AK. Why hysterectomy rate are lower in India. Indian J Commu Med 2008;33:196-7.
2Rajeshwori BV, Hishikar V. View and review of hysterectomy - A retrospective study of 260 cases over a period of one year. Bombay Hosp J 2008;50:1.
3Gupta G, Kotasthae DS. Hysterectomy: A clinico-pathological correlation of 500 cases. Intern J Gynecol Obstet 2010;14:1.
4Shergill SK, Shergill HK, Gupta M, Kaur S. Clinico-pathological study of hysterectomies. J India Med Assoc 2002;100:238-9.
5Najam R, Bansal P, Sharma R, Agarwal D. Emergency obstetric hysterectomy: A retrospective study at a tertiary care centre. J Clin Diagn Res 2010;4:2864-8.
6Aksu F, Gezer A, Oral E. Seventeen year review of hysterectomy procedure in university clinic in Istanbul from 1985-2001. Arch Gynecol Obstet 2004;270:217-22.
7Maresh MD, Metcalfe MA, Mcpherson. The VALUE national hysterectomy study: Description of patient and surgery. BJOG 2002;109:302-12.