Natural history of postoperative neuropathies in gynecologic surgery

Abstract

Introduction and hypothesis

Neuropathy following pelvic surgery is an uncommon but important complication. The current literature about the natural history and treatment of these neuropathies is limited. We aim to describe the characteristics, treatments and natural history of postoperative neuropathy following benign gynecologic surgery.

Methods

This retrospective case series included patients who underwent benign gynecologic surgery for ≥ 60 min in lithotomy. Patients with preexisting neurologic disease were excluded. Patient demographics, identification of postoperative neuropathy and details regarding evaluation and treatment were obtained from the medical record. Neuropathies were characterized by anatomic location and nerve/dermatome distribution. Duration of symptoms was classified as < 1 week, 1 week to 3 months or > 3 months with neuropathy symptoms grouped as resolved, persistent but improved or persistent. Data were analyzed with appropriate descriptive statistics, Pearson correlation and chi-square test.

Results

The study included 2449 patients who had undergone benign gynecologic surgery, with 78 (3.2%) patients identified as having postoperative neuropathy. Most patients with neuropathies demonstrated either complete resolution [59 (75.6%)] or persistent but improved [13 (16.7%)] symptoms. Twenty-eight (35.9%) had symptoms of ≥ 3 months. Most neuropathies were sensory only [63 (80.8%)], and the most frequently documented nerve distribution was femoral [23 (29.5%)]. Evaluation and treatment of neuropathy most commonly included physical therapy consult [17 (21.8%)] and neurology consult [8 (10.3%)].

Conclusions

The incidence of postoperative neuropathy in this large, benign gynecologic surgery population was 3.2%. Most neuropathies are sensory only and self-limited. While physical therapy was the most common treatment, most patients received no specific intervention.