complications do we cause when we operate? Data from The Swedish National Register on Gynecologic Surgery

Transcription

1 How many and how serious complications do we cause when we operate? Data from The Swedish National Register on Gynecologic Surgery Jan-Henrik Stjerndahl Ass Prof. MD. PhD. Dept of Obstet & Gynecology Sahlgrenska University Hospital Göteborg, Sweden

2 The Gynop Register Started as a pilot project in 6 clinics 10 years ago Over hysterectomies from 37 clinics included the last 3 years Of which hysterectomies due to benign disorder

3 Attending clinics and number of patients Clinic Karolinska n Clinic 208 Kalmar n Clinic 79 Mora Gävle 264 n Södertälje 37 Visby Uppsala 35 Malmö 195 Sundsvall 195 Nyköping 13 Lund 367 Örnsköldsvik Östersund 308 Linköping 357 Helsingborg Norrköping 621 Ystad Motala Umeå Halmstad 442 Skellefteå 212 Jönköping 420 Varberg 379 Lycksele 141 Eksjö 315 Sahlgrenska S/Ö Värnamo 294 Trollh./Uddevalla 820 Gällivare 156 Växjö 524 Borås 334 Läkargr. Örebro 138 Ljunby Västervik 61 Skövde 389 Falun Sunderbyn Total 11693

4 Urinary Tract Infection P V I T A R E P OST O HEMATOM A R E V E FE BL EE DIN G

5 How and when complications are reported to the register Complications reported by 2 months and 1 Year after Complications the patient reported and assessed by the doctor surgery, assessed by the patient and the doctor peroperative, Complications reported and assessed by the doctor when the patient is discharged from Hospital

6

7 Complications caused by surgery What is a serious complication?

8 What is a serious complication? Assesment of complications Patient s assessment Doctor s assessment No Minor Serious No answer Total No complication Minor complication Serious complication No answer Total

9 How often does a serious complication occur? 6,7 according to the patient 2,2 according to the doctor Who is right?

10 Compications discovered at surgery Data from hysterectomies, op time 79 min Minor Kind of complication Bleeding Bladder Ureter Bowel Vessel Other Serious Op time Op time 4, , , , , , , ,04 146

11 Bleeding complication (Bleeding volume in ml)

12 Complications discovered at surgery Data from hysterectomies

13 Complications reported at discharge Complications peroperative, reported and assessed by the doctor Komplikationer Complications reported registrerade och and assessed by thevid bedömda av läkare doctor when the utskrivningen patient is discharged from Hospital Complications reported by the patient 2 months after surgery, assessed by the patient and the doctor

14 Complications recorded at discharge Data from Hysterectomies Bleeding complications Intra abdominell Vaginal cuff Abdominal wall Vaginally Other Minor Serious 0,7 0,8 0,8 0,9 0,04

15 2 Complications recorded at discharge Data from Hysterectomies Complication (Tissue/Organ) Bladder Ureter Bowel Nerv Vessel Wound rupture Other Minor Serious 0,6 0,02 0,05 0,02 0,04 0,04 0,03

16 3 Complications recorded at discharge Data from Hysterectomies Minor Serious Lower urinary tract 1,0 Vaginal cuff Intra abdominally 0,03 Abdominal wall 0,03 Infection Sepsis Pyelonephritis Other 0,01 0,03 0,01

17 4 Complications recorded at discharge Data from Hysterectomies Minor Serious Unusual post-operative pain 0,8 Astenia 0,3 0,04 Heart disease 0,04 Ileus 0,03 CNS 0,03 0,02 0,01 Varia Urinary incontinence Trombosis Other 0,01 0,8

18 Complications, all included, reported at discharge Abdom 7712 op Vaginal 3174 op Laparosc 561 op Minor 10,7 8,6 6,8 Serious 2,5 3,1 4,3

19 Complications reported 2 month after surgery Complications peroperative, reported and assessed by the doctor Complications reported and assessed by the doctor at discharge Complications reported by the patient 2 months after surgery, assessed by the patient and the doctor

20 Complications reported by patients 2 months after surgery, assessed by doctor Data from 9600 Hysterectomies Minor Serious Affected organ/tissue Wound/Scar 5,4 0,5 Bladder 3,9 0,4 Bowel 2,3 0,4 Vessel 0,5 Ureter 0,4 Nerv 1,5 Wound rupture Fistula Other 3,4 0,5

21 2 Complications reported by patients 2 months after surgery, assessed by doctor Data from 9600 Hysterectomies Minor Serious Intra abdominally Abdominal wall 1,1 0,5 1,4 Vagina Other 1,0 1,1 Bleeding complications

22 3 Complications reported by patients 2 months after surgery, assessed by doctor Data from 9600 Hysterectomies Minor Serious UTI Intra abdom 3,2 0,4 1,0 0,3 Abdom wall Vaginal cuff 2,6 1,6 Sepsis Other 0,02 0,7 Infections

23 Percent postoperative infections Infection 0,0 2,0 4,0 6,0 8,0 10,0 12,0 14,0 16,0 Hysterektomi p<0.001 Totala hysterektomi p<0.001 Subtotal hysterektomi p<0.05 Abdominell total hysterektomip< Abdominel subtotal hysterektomip<0.05 Laparaskopisk subtotal hysterektomi p=n.s Vaginal hysterektomi p<0.05 Ab profylax given Ab profylax ej given

24 Profylactic antibiotic treatment Number Yes No No answer Feed-back information to the clinics resulted in increased profylactic treatment before surgery from 50 to 85 in 2 years!

25 4 Complications reported by patients 2 months after surgery, assessed by doctor Data from 9600 Hysterectomies Other complications Minor Serious 13,2 1,8 Astenia 5,2 0,9 Dysuria 2,4 0,3 Ileus 0,5 Urinary incontinens 1,7 Trombosis Urinary retention 0,5 Others 2,9 0,6 Unusual post operative pain

26 Summery Frequency of operations where complication have been reported Accumulated frequency at different occations Data from hysterectomies At At 2 months surgery discharge postop Minor 5,5 12,7 29,7 Serious 0,7 2,3 4,3

27 Minor complications Frequency of operations where a minor complication have been reported Laparosc (n=559) Vaginal (n=3150) Abdom (n=7600) Surgery Discharge 2 months

28 Serious complications Frequency of operations where a serious complication have been reported

29 Patient satisfaction 2 years post hysterectomy Patient satisfaction 2-years post hysterektomy Bleeding Pain Preasure Other 0 Very satisfied Satisfied Neutral Disappointed Very disappointed 100 Missing

30 How to awoid complications Learn from misstakes! Training! Mentorship!

31 Thank You for your attention! Welcome to Göteborg!!