Audit on Hysterectomies Done in a Tertiary Care Center: Addressing the Dilemma on Retaining the Uterus From Womb to Tomb

Introduction This study attempts to determine whether hysterectomies in tertiary care centers are avoidable and explores the possibility of retaining all uteri from womb to tomb. Objectives The objective of this study is to determine the incidence of women less than 35 years of age, bilateral salpingo-oophorectomy in women less than 40 years of age, insufficient documentation of indication or prior conservative treatment for the symptoms, discrepancy between indication for surgery and histopathological examination reports, and associated with severe postoperative morbidity or mortality. Methods This is a retrospective cohort study reviewing medical records of patients admitted for hysterectomy for various indications in a tertiary center in north-east India. Results Among 201 hysterectomies, the most common indication was abnormal uterine bleeding with the most common histopathological finding being leiomyoma; 3.5% of women were under 35 years, 32 women were below 40 years of which only one (0.5%) had bilateral salpingo-oophorectomy. All case records mentioned the indication for surgery, though lacking details of prior treatments. The concordance rate between surgeons' indication and final histopathological examination reports was high, with Spearman's correlation coefficient of 0.82. Conclusion Though all attempts should be made toward conserving the uterus with benign pathologies, especially those with abnormal uterine bleeding, many of the hysterectomies in tertiary centers are likely to be unavoidable, as most of the patients are secondary referrals from other centers where conservative management may have failed.