INTRA-Operative and Post-Operative Common Complications of Hysterectomy

Abstract

Background: Hysterectomy is a common gynecological procedure with potentially significant intra-operative and early post-operative morbidity; context-specific complication profiling is essential to optimize surgical planning, training allocation, and perioperative safety. Objective: To determine the incidence and pattern of intra-operative and early post-operative complications among women undergoing hysterectomy in a tertiary-care hospital and to assess associations with surgical route and key perioperative risk factors. Methods: A hospital-based cross-sectional observational study was conducted at Jinnah Hospital from 1 January 2024 to 30 April 2024. Consecutive eligible women undergoing vaginal, abdominal, or laparoscopic hysterectomy were enrolled after informed consent, excluding patients with severe systemic comorbidities. Standardized definitions were used to record intra-operative events (e.g., bladder/bowel/ureteric injury, hemorrhage) and early post-operative outcomes (e.g., bleeding, surgical-site infection, hematoma) during index admission/within 7 days. Associations were examined using chi-square/Fisher’s exact tests and multivariable logistic regression. Results: Among 94 hysterectomies, any intra-operative complication occurred in 55.3% (52/94; 95% CI: 45.2–65.1) and any early post-operative complication in 53.2% (50/94; 95% CI: 43.1–63.1). Complication incidence was lower after vaginal hysterectomy (intra-operative 44.9%; post-operative 42.9%) than abdominal hysterectomy (66.7%; 64.1%). Prior pelvic surgery independently predicted intra-operative (aOR 3.02; 95% CI: 1.10–8.28; p=0.03) and early post-operative complications (aOR 2.76; 95% CI: 1.01–7.55; p=0.04); operative duration ≥120 minutes predicted intra-operative complications (aOR 2.89; 95% CI: 1.09–7.64; p=0.03), and abdominal route predicted early post-operative morbidity (aOR 2.58; 95% CI: 1.00–6.65; p=0.05). Conclusion: Perioperative complications were frequent, with higher risk associated with prior pelvic surgery, prolonged operative duration, and abdominal approach; prioritizing vaginal routes when feasible and strengthening risk-stratified perioperative protocols may reduce morbidity.