how many and how serious complications do we cause ... -...
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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
MinorMinor SeriousSerious
%% %%
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)
MinorMinor SeriousSerious
%% %%
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
Vaginal cuffVaginal cuff 0,20,2 0,10,1
Intra abdominallyIntra abdominally 0,10,1 0,030,03
Abdominal wallAbdominal wall 0,20,2 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
OtherOther 0,80,8 0,10,1
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
MinorMinor SeriousSerious
%% %%
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
OtherOther 3,43,4 0,50,5
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
MinorMinor SeriousSerious
%% %%
Intra abdominallyIntra abdominally 1,11,1 0,50,5
Abdominal wallAbdominal wall 1,41,4 0,20,2
VaginaVagina 1,01,0 0,10,1
OtherOther 1,11,1 0,10,1
3 3 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
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
Vaginal cuffVaginal cuff 1,61,6 0,10,1
SepsisSepsis 0,10,1 0,020,02
OtherOther 0,70,7 0,20,2
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!
4 4 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
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!!