Hysterectomy trends and outcomes: an ambispective audit from a tertiary institute in Northern India

Hysterectomy is one of the most commonly performed gynecological surgeries worldwide. This study aimed to evaluate the clinical indications, surgical routes, and intraoperative and postoperative outcomes of hysterectomies performed at a tertiary care center over an 8-year period.

This ambispective observational study was conducted from February 2016 to May 2024. It included 1,083 women who underwent hysterectomy for benign, malignant, or obstetric indications via abdominal, laparoscopic, vaginal, or robotic approaches. Data were collected retrospectively (2016-2022) and prospectively (2022-2024). Parameters analyzed included patient demographics, indications, surgical approach, anesthesia, blood loss, complications, and transfusion requirements. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 25.0 (IBM Corp., Armonk, NY, USA).

Of 1,083 cases, 84.21% were performed for benign and 15.78% for malignant conditions. Abdominal hysterectomy was most common (44.41%), followed by robotic (39.52%), vaginal (12.00%), and laparoscopic (4.07%). Robotic hysterectomy had the lowest blood loss (median 52.5 mL) and transfusion rates (intraoperative, 0.47%; postoperative, 1.40%), compared with abdominal (median 300 mL; intraoperative, 18.71%, postoperative, 13.30%). Vaginal hysterectomy had the shortest operative time but slightly higher blood loss than minimally invasive approaches. Major complications such as bladder, bowel, and ureteric injuries were more frequent in abdominal cases.

Minimally invasive techniques, especially robotic surgery, are associated with reduced blood loss and complication rates. This audit highlights the need to encourage minimally invasive hysterectomy where feasible and underscores the importance of systematic documentation to inform practice and policy improvements.