Predictors of Adverse Outcomes after Myomectomy in Low-Resource Settings: A Prospective Analysis from Douala, Cameroon

Introduction: Uterine fibroids are the most common benign tumors in women of reproductive age and often require surgical management. Myomectomy, the reference conservative treatment, nevertheless remains associated with a high risk of postoperative complications in resource-limited settings. Objective: To identify predictive factors of unfavorable outcomes after myomectomy in a resource-limited context. Methods: A longitudinal observational study with prospective data collection was conducted among 124 patients operated in referral hospitals in Douala, Cameroon. Sociodemographic, clinical, and operative characteristics were collected. Factors associated with postoperative complications were analyzed using multivariate logistic regression. Results: The mean age of patients was 39 ± 6 years. Laparotomy was the main surgical approach (95.2%). Unfavorable outcomes were significantly associated with surgical indication for menorrhagia (OR = 2.60 [1.30 - 5.10]; p = 0.006), operative duration >120 minutes (OR = 3.10 [1.50 - 6.30]; p = 0.002), removal of more than five fibroids (OR = 1.80 [1.10 - 3.00]; p = 0.021), absence of preoperative staff consultation (OR = 3.87 [1.65 - 9.05]; p = 0.002), and surgical experience <5 years (OR = 4.17 [1.33 - 13.03]; p = 0.014). Age ≥ 40 years and non-use of a tourniquet were not significantly associated. Conclusion: In resource-limited settings, unfavorable outcomes after myomectomy are mainly determined by surgical complexity and organization of care. Systematic implementation of preoperative staff consultations, assignment of complex cases to experienced surgeons, and adoption of blood-sparing protocols could significantly reduce postoperative morbidity.