how many and how serious complications do we cause ... -...

How How manymany and and howhow serious serious complications do complications do wewe causecause

when we operate?when we operate?Data from The Swedish National Register on Data from The Swedish National Register on

Gynecologic SurgeryGynecologic Surgery

Jan-Henrik StjerndahlJan-Henrik StjerndahlAss Prof. MD. PhD.Ass Prof. MD. PhD.

Dept of Obstet & GynecologyDept of Obstet & GynecologySahlgrenska University HospitalSahlgrenska University Hospital

Göteborg, Sweden Göteborg, Sweden

The Gynop RegisterThe Gynop Register

Started as a pilot project in 6 Started as a pilot project in 6 clinics 10 years agoclinics 10 years ago

Over 15 000 Over 15 000 hysterectomies hysterectomies from from 37 clinics included the last 3 37 clinics included the last 3 yearsyears

Of which 11 693 hysterectomies Of which 11 693 hysterectomies due to benign disorderdue to benign disorder

Attending clinics and number of patientsAttending clinics and number of patients ClinicClinic nn ClinicClinic nn ClinicClinic nn

KarolinskaKarolinska 208208 KalmarKalmar 7979 MoraMora 205205

SödertäljeSödertälje 3737 VisbyVisby 6868 GävleGävle 264264

UppsalaUppsala 3535 MalmöMalmö 195195 SundsvallSundsvall 195195

NyköpingNyköping 1313 LundLund 367367 ÖrnsköldsvikÖrnsköldsvik 106106

LinköpingLinköping 357357 HelsingborgHelsingborg 917917 ÖstersundÖstersund 308308

NorrköpingNorrköping 621621 YstadYstad 55 UmeåUmeå 379379

MotalaMotala 183183 HalmstadHalmstad 442442 SkellefteåSkellefteå 212212

JönköpingJönköping 420420 VarbergVarberg 379379 LyckseleLycksele 141141

EksjöEksjö 315315 Sahlgrenska S/ÖSahlgrenska S/Ö 16231623 SunderbynSunderbyn 458458

VärnamoVärnamo 294294 Trollh./UddevallaTrollh./Uddevalla 820820 GällivareGällivare 156156

VäxjöVäxjö 524524 BoråsBorås 334334 Läkargr. ÖrebroLäkargr. Örebro 138138

LjunbyLjunby 6161 SkövdeSkövde 403403

VästervikVästervik 389389 FalunFalun 4242 TotalTotal 1169311693

UrinaryUrinaryTractTract

InfectionInfection

HEMATOMAHEMATOMA

POST OPERATIVE FEVER

BLEEDING

BLEEDING

How and when complications are How and when complications are reported to the registerreported to the register

Complications

peroperative, reported and assessed by the doctor

Complications reported and assessed by the doctor when the patient

is discharged from Hospital

Complications reported by

the patient 2 months and 1 Year after surgery, assessed by the patient and the doctor

Complications caused Complications caused by surgeryby surgery

What is a serious What is a serious complication?complication?

What is a serious complication?What is a serious complication?

Assesment of complications Patient´s assessment

Doctor´s assessment

No Minor Serious No answer

Total

No complication

5385 100 10 170 5665

Minor complication

1388 1424 39 112 2963

Serious complication

146 323 169 31 669

No answer 195 26 9 62 292

Total 7114 1873 227 375 9589

How often does a serious How often does a serious complication occur?complication occur?

6,7 % according to6,7 % according to the patientthe patient 2,2 % according to2,2 % according to the doctorthe doctor Who is right?Who is right?

Compications discovered at surgeryCompications discovered at surgery Data from 11693 hysterectomies, op time 79 minData from 11693 hysterectomies, op time 79 min

Kind of Kind of complicationcomplication

MinorMinor SeriousSerious

%% Op timeOp time %% Op timeOp time

BleedingBleeding 4,44,4 106106 0,50,5 150150

BladderBladder 0,70,7 117117 0,20,2 131131

UreterUreter 0,040,04 140140 0,10,1 173173

BowelBowel 0,30,3 107107 0,10,1 140140

VesselVessel 0,040,04 8787 0,050,05 147147

OtherOther 0,20,2 123123 0,040,04 146146

Bleeding complication Bleeding complication (Bleeding volume in ml)(Bleeding volume in ml)

Complications discovered at surgeryComplications discovered at surgery Data from 11693 hysterectomiesData from 11693 hysterectomies

Complications reported at Complications reported at dischargedischarge

Complications peroperative, reported and assessed by the doctor

Komplikationer registrerade och bedömda av läkare vid

utskrivningen

Complications reported by the patient 2 months after surgery, assessed by the patient and the doctor

Complications reported and assessed by the doctor when the patient is discharged from Hospital

Complications recorded at dischargeComplications recorded at discharge Data from 11693 HysterectomiesData from 11693 Hysterectomies

Bleeding Bleeding complicationscomplications


%% %%

Intra abdominellIntra abdominell 0,70,7 0,80,8

Vaginal cuffVaginal cuff 0,80,8 0,20,2

Abdominal wallAbdominal wall 0,90,9 0,20,2

VaginallyVaginally 0,20,2 0,040,04

OtherOther 0,20,2 0,10,1

22

Complications recorded at dischargeComplications recorded at discharge Data from 11693 HysterectomiesData from 11693 Hysterectomies

Complication Complication (Tissue/Organ)(Tissue/Organ)


%% %%

BladderBladder 0,60,6 0,20,2

UreterUreter 0,020,02 0,10,1

BowelBowel 0,10,1 0,10,1

NervNerv 0,10,1 0,050,05

VesselVessel 0,020,02 0,040,04

Wound ruptureWound rupture 0,10,1 0,040,04

Other Other 0,20,2 0,030,03

3 3 Complications recorded at dischargeComplications recorded at discharge Data from 11693 HysterectomiesData from 11693 Hysterectomies

InfectionInfectionMinorMinor SeriousSerious

%% %%

Lower urinary tractLower urinary tract 1,01,0 0,20,2


Intra abdominallyIntra abdominally 0,10,1 0,030,03


SepsisSepsis 0,010,01

PyelonephritisPyelonephritis 0,030,03

OtherOther 0,20,2 0,010,01

4 4 Complications recorded at dischargeComplications recorded at discharge Data from 11693 HysterectomiesData from 11693 Hysterectomies

VariaVariaMinorMinor SeriousSerious

%% %%

Unusual post-operative painUnusual post-operative pain 0,80,8 0,10,1

AsteniaAstenia 0,30,3 0,040,04

Heart diseaseHeart disease 0,10,1 0,040,04

IleusIleus 0,10,1 0,030,03

CNSCNS 0,10,1 0,030,03

Urinary incontinenceUrinary incontinence 0,020,02 0,010,01

TrombosisTrombosis 0,010,01


Complications, all included, reported Complications, all included, reported at dischargeat discharge

Abdom Abdom 7712 op7712 op

Vaginal Vaginal 3174 op3174 op

Laparosc Laparosc 561 op561 op

%% %% %%

MinorMinor 10,710,7 8,68,6 6,86,8

SeriousSerious 2,52,5 3,13,1 4,34,3

Complications reported 2 month Complications reported 2 month after surgeryafter surgery

Complications peroperative, reported and assessed by the doctor

Complications reported by the patient 2 months after surgery, assessed by the patient and the doctor

Complications reported and assessed by the doctor at discharge

Complications reported by patients 2 Complications reported by patients 2 months after surgery, assessed by doctormonths after surgery, assessed by doctorData from 9600 HysterectomiesData from 9600 Hysterectomies

Affected Affected organ/tissueorgan/tissue


%% %%

Wound/ScarWound/Scar 5,45,4 0,50,5

BladderBladder 3,93,9 0,40,4

BowelBowel 2,32,3 0,40,4

VesselVessel 0,50,5 0,20,2

UreterUreter 0,40,4 0,20,2

NervNerv 1,51,5 0,20,2

Wound ruptureWound rupture 0,20,2 0,20,2

FistulaFistula 0,10,1 0,10,1


2 2 Complications reported by patients 2 Complications reported by patients 2 months after surgery, assessed by doctormonths after surgery, assessed by doctorData from 9600 HysterectomiesData from 9600 Hysterectomies

Bleeding Bleeding complicationscomplications


%% %%

Intra abdominallyIntra abdominally 1,11,1 0,50,5


VaginaVagina 1,01,0 0,10,1



InfectionsInfectionsMinorMinor SeriousSerious

%% %%

UTIUTI 3,23,2 0,40,4

Intra abdomIntra abdom 1,01,0 0,30,3

Abdom wallAbdom wall 2,62,6 0,10,1


SepsisSepsis 0,10,1 0,020,02


Percent postoperative infectionsPercent postoperative infections

0,0 2,0 4,0 6,0 8,0 10,0 12,0 14,0 16,0

Hysterektomi p<0.001

Totala hysterektomip<0.001

Subtotal hysterektomip<0.05

Abdominell totalhysterektomip< 0.005

Abdominel subtotalhysterektomip<0.05

Laparaskopisk subtotalhysterektomi p=N.S

Vaginal hysterektomip<0.05

% Infection

Ab profylax given

Ab profylax ej given

Profylactic antibiotic treatmentProfylactic antibiotic treatment

YesYes NoNoNo No

answeranswer

NumberNumber 97959795 15391539 359359

Feed-back information to the Feed-back information to the clinics resulted in increased clinics resulted in increased profylactic treatment before profylactic treatment before surgery from 50% to 85 % in 2 surgery from 50% to 85 % in 2 years! years!


Other complicationsOther complications MinorMinor%%

SeriousSerious%%

Unusual post operative painUnusual post operative pain 13,213,2 1,81,8

AsteniaAstenia 5,25,2 0,90,9

DysuriaDysuria 2,42,4 0,30,3

IleusIleus 0,50,5 0,20,2

Urinary incontinensUrinary incontinens 1,71,7 0,20,2

TrombosisTrombosis 0,10,1 0,10,1

Urinary retentionUrinary retention 0,50,5 0,10,1

OthersOthers 2,92,9 0,60,6

SummerySummeryFrequency of operations where complication Frequency of operations where complication

have been reportedhave been reportedAccumulated frequency at different occationsAccumulated frequency at different occations

Data from 11693 hysterectomiesData from 11693 hysterectomies

At At surgerysurgery

At At dischargedischarge

2 months 2 months postoppostop

%% %% %%

MinorMinor 5,55,5 12,712,7 29,729,7

SeriousSerious 0,70,7 2,32,3 4,34,3

Minor complicationsMinor complicationsFrequency of operations where a minor Frequency of operations where a minor

complication have been reportedcomplication have been reported

0%

5%

10%

15%

20%

25%

30%

35%

40%

Surgery Discharge 2 months

Laparosc (n=559)

Vaginal (n=3150)

Abdom (n=7600)

Serious complicationsSerious complicationsFrequency of operations where a serious Frequency of operations where a serious

complication have been reportedcomplication have been reported

Patient satisfaction 2 years Patient satisfaction 2 years post hysterectomypost hysterectomy

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Other

Preasure

Pain

Bleeding

Patient satisfaction 2-years post hysterektomy

Very satisfied Satisfied Neutral Disappointed Very disappointed Missing

How to awoid complicationsHow to awoid complications

Learn fromLearn frommisstakes!misstakes!Training!Training!Mentorship!Mentorship!

Thank You for your attention! Thank You for your attention!

Welcome to Göteborg!!

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