Hemorragia postoperatoria en histerectomía por patología benigna: Estudio unicéntrico

espanolIntroduccion: la histerectomia es la intervencion quirurgica mas frecuente en el ambito de la ginecologia. Si bien se trata de un procedimiento de bajo riesgo, las infecciones y la hemorragia post-operatoria son sus principales complicaciones. Nuestro objetivo ha sido evaluar la hemorragia post-operatoria en nuestro medio durante la realizacion de histerectomias por patologia benigna. Material y metodos: durante 2 anos se ha realizado una recogida prospectiva de todos los casos de histerectomia realizados en contexto de patologia benigna en unico centro. Realizamos un estudio descriptivo de las caracteristicas de los pacientes y un analisis univariado de la hemorragia post-operatoria significativa (perdida de hemoglobina mayor a 2g/dl). Resultados: de un total de 256 histerectomias; 125 (48.8%) han sido totales y 131 (51.2%) subtotales. La edad media de los pacientes era de 49.1 ± 8,7 anos y la tasa de hemorragia significativa ha sido del 62.5% (n=160). El unico predictor de hemorragia significativa ha sido la cirugia abierta (95 vs 87.5%, p=0,05), sin diferencias significativas en el tipo de histerectomia, la realizacion de anexectomia concomitante o en el tiempo de cirugia. La necesidad de transfusion ha sido mayor (4.4 vs 0%, p=0.048) pero no la necesidad de reintervencion (3.8 vs 5.2%, p=0.752). No se han producido exitus. Conclusion: La hemorragia significativa definida por la perdida de 2 g/dl de hemoglobina es una complicacion frecuente de la histerectomia por patologia benigna, siendo uno de sus predictores la via quirurgica abierta. EnglishIntroduction: the hysterectomy is the most frequent surgical procedure in gynecology. It is a low risk procedure, but infections and post-operative bleeding are their main complications. Our aim has been to evaluate the post-operative bleeding in our environment in the context of hysterectomies due to benign pathology. Material and methods: during 2 years we have been prospectively recruiting all of the hysterectomies performed in our centre due to benign pathology. We did a descriptive study of the main features of these patients and a univariate analysis of significant post-operative bleeding (lost of hemoglobin more than 2 g/dl). Results: among 256 hysterectomies, 125 (48.8%) have been total hysterectomies and 131(51.2%) subtotal hysterectomies. Mean age of patients was 49.1 ± 8,7 years old and the rate of significant post-operative bleeding was 62.5% (n=160). The unique predictor of significant bleeding was the open operative surgical procedure (95 vs 87.5%, p=0,05), without significant differences among the type of hysterectomy, the concomitant annexectomy or the surgery duration. Need of transfusion was greater (4.4 vs 0%, p=0.048) but not the need of new intervention (3.8 vs 5.2%, p=0.752). There were no deaths. Conclusion: significant postoperative bleeding defined by the lost of haemoglobin greater than 2g/dl is a frequent complication of hysterectomy in the context of benign pathology, being the open operative surgical procedure one of its predictors.