Abstract

Background: Hysterectomy is one of the most common gynaecological procedures performed worldwide. The magnitude of the complications related to hysterectomy and risk factors differ based on the patient’s features, surgical training level, and availability of technical resources. Hysterectomy rates, complications, and associated risk factors are declining in high-income countries. However, despite the rising trend in the number of hysterectomies performed in low and middle-income countries, including Cameroon, the exact burden is scarcely defined in our setting.

Objective: This study aimed to determine the prevalence and indications and examine the outcomes of hysterectomy at four hospitals in the South West region of Cameroon (Limbe Regional Hospital, Buea Regional Hospital, Baptist Hospital Mutengene and District Hospital Kumba).

Materials and Methods: This was a seven year-hospital-based-retrospective cross- sectional study. Hospital records of women who underwent hysterectomy from the 1st January 2015 to 31st December 2021 at Buea regional hospital, Limbe regional hospital, Baptist Mutengene and Kumba district Hospital were included. Data were analyzed using SPSS version 26.0. Multiple logistic regression analysis was used to identify factors associated with the route of hysterectomy and those with poor outcomes. Statistical significance was set at a p-value<0.05, with a confidence interval of 95%.

Results: The prevalence of hysterectomy was 18.2%. The most common indications were symptomatic uterine fibroid (60.4%) and gynaecological cancers (12.5%). Most participants (87.5%) underwent a total abdominal hysterectomy. Post-operative morbidity was recorded in 88 (43.8%) cases. Post-operative anemia (13.10%) and fever (11.83%) were the commonest complications. The in-hospital mortality rate was 2.6%. Concurrent surgical procedures [AOR=0.086 (0.026-0.28), p<0.001], surgeon’s specialization [AOR=5.3 (1.4-19.6), p=0.013], and symptomatic uterine leiomyoma [AOR=0.061 (0.02-0.18), p<0.001] were determinants of the choice of the route of hysterectomy. Intra-operative complications [AOR=4.46 (1.63-7.36), p<0.001], hysterectomy performed by a non-gynecologic surgeon [AOR=2.57 1.22-5.40), p=0.013], and vaginal hysterectomy [AOR=0.169 (0.05-0.73), p=0.018] were associated with postoperative complications, and intra-operative [AOR=5.9 (1.9-18.3), p=0.02] and postoperative complications (AOR=6.7 (3.2-13.9), p<0.001], surgeon’s specialization [AOR=0.3 (0.1-0.7), p=0.017], vaginal hysterectomy [AOR=0.4 (0.1- 0.9), p=0.018] and radical hysterectomy [AOR=10.5 (1.3-83.7), p=0.026] were found to be associated with a prolonged hospital stay.

Conclusion: Total abdominal hysterectomy for benign conditions is the most performed in our setting and is associated with high postoperative morbidity. Improving the practice of vaginal hysterectomy and minimally invasive techniques through providing infrastructures and specialized training programs for practitioners may help reduce post- operative morbidities and length of hospitalization.

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