Systematic review of medical audits of hysterectomy practices in India
Archana Kumari, Reeta Mahey, Hemali Heidi Sinha, Mukta Agarwal, Piyush Ranjan, Aditi Verma, Divjyot Kaur, Roopal Jyoti Singh, Sapna Desai, Neerja BhatlaBackground and objectives
The utilisation of hysterectomy has emerged as a public health concern in India. The Ministry of Health’s National Guidelines aim to reduce unnecessary hysterectomies by promoting adherence to recommended indications, age, and extent of surgery. Although audits are routinely conducted in tertiary hospitals, their findings have not been synthesised. We present a synthesis of medical audits of hysterectomy practices in India to identify patterns, gaps, and opportunities to improve the quality of care.
Methods
This systematic review included medical audits of hysterectomies in India published between 2010 and 2024 across PubMed, Scopus, and EMBASE. Using PRISMA guidelines, a systematic search and narrative synthesis were conducted to examine clinical indications, surgical route, complications, and histopathological correlations. Study selection and quality assessment were carried out independently by two reviewers using the Joanna Briggs Institute critical appraisal tool.
Results
The review included 89 medical audits, mostly of moderate quality. Hysterectomies were predominantly performed in premenopausal women, with one-fourth in women under 40 years. The leading indications were abnormal uterine bleeding and fibroids, commonly managed by abdominal surgery. Oophorectomy was frequently performed without documented ovarian pathology. Reported complications included haemorrhage, postoperative fever, and urinary tract infections.
Interpretation and conclusions
This review identified benign gynaecological conditions, particularly fibroids, as the predominant indication for hysterectomy. It also revealed substantial gaps in standardised reporting, clinicopathological documentation, and sociodemographic data. Strengthening audit systems, ensuring adherence to evidence-based guidelines, and expanding access to conservative and minimally invasive treatments are essential to support rational surgical decision-making and improve the quality of gynaecological care.