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On the Mode of Hysterectomy: with Emphasis on Recovery and Well‐Being
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Obstetrik och gynekologi. Linköpings universitet, Hälsouniversitetet.
2009 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

Hysterectomy is the surgical removal of the uterus and it is the most common major gynaecological surgical procedure worldwide. Hysterectomy is most often indicated by benign conditions such as irregular uterine bleeding with or without uterine fibroids. Several modes of hysterectomy are available each using a different surgical approach. Psychological well‐being and recovery after hysterectomy have not been carefully investigated in randomised settings. The aims of this thesis were to evaluate different modes of hysterectomy regarding postoperative psychological well‐being in long‐term follow‐up 6 and 12 months after surgery and recovery of general well‐being in short‐term up to five weeks after surgery. Additional objectives were to study the influence of the women’s stress‐coping ability on postoperative psychological well‐being and also to analyse other factors associated with postoperative psychological well‐being and recovery of general well‐being. In a randomised trial (trial 1) of 125 women who had undergone laparoscopic hysterectomy (LH) and abdominal hysterectomy (AH), no significant difference was found between the postoperative psychological well‐being of women in the two groups as indicated by four different psychometric measures up to 6 months after surgery. Neither did the day‐by‐day recovery of general well‐being differ between the women in the two hysterectomy groups, even when adjusted for consumption of analgesics. A high stress‐coping ability was strongly associated with a higher level of psychological well‐being preoperatively and a significantly faster recovery of general well‐being regardless of surgical method. In another randomised trial (trial 2) of 179 women who had undergone subtotal abdominal hysterectomy (SH) and total abdominal hysterectomy (TH), with a follow‐up time of one year, no significant difference in psychological well‐being was found between the two methods. The day‐by day recovery of general well‐being was the same in both groups. In both trial 1 and trial 2, longterm psychological well‐being improved over time during the study period regardless of the mode of hysterectomy. The occurrence of postoperative complications and a low preoperative level of psychological well‐being impair postoperative recovery significantly and prolong the duration of sick‐leave. In conclusion, the suggested benefits of the less invasive modes of hysterectomy, LH and SH, could not be proven in this study Recovery of general well‐being is associated with the woman’s stress‐coping and preoperative psychological well‐being and the studied modes of hysterectomy seem to be of less importance. This should be taken into account in preoperative counselling. Doing this will give patient and surgeon an open choice of the mode of hysterectomy to be chosen, since short‐term recovery and long‐term psychological well‐being seem to be the same in both groups in the long term.

sted, utgiver, år, opplag, sider
Linköping: Linköping University Electronic Press , 2009. , s. 77
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1104
HSV kategori
Identifikatorer
URN: urn:nbn:se:liu:diva-18476ISBN: 9789173936873 (tryckt)OAI: oai:DiVA.org:liu-18476DiVA, id: diva2:219752
Disputas
2009-06-08, Berzeliussalen, Campus US, Linköpings Universitet, Linköping, 13:00 (engelsk)
Opponent
Veileder
Tilgjengelig fra: 2009-05-28 Laget: 2009-05-28 Sist oppdatert: 2019-06-28bibliografisk kontrollert
Delarbeid
1. Psychological wellbeing after laparoscopic and abdominal hysterectomy--a randomised controlled multicentre study
Åpne denne publikasjonen i ny fane eller vindu >>Psychological wellbeing after laparoscopic and abdominal hysterectomy--a randomised controlled multicentre study
2006 (engelsk)Inngår i: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 113, nr 9, s. 1023-30Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

OBJECTIVE: To compare laparoscopic hysterectomy and abdominal total hysterectomy regarding influence on postoperative psychological wellbeing and surgical measures. DESIGN: A prospective, open, randomised multicentre trial.

SETTING: Five hospitals in the South East of Sweden.

POPULATION: Hundred and twenty-five women scheduled for hysterectomy for benign conditions were enrolled in the study, and 119 women completed the study. Fifty-six women were randomised to abdominal hysterectomy and 63 to laparoscopic hysterectomy.

METHODS: Psychometric tests measuring general wellbeing, depression and anxiety preoperatively and 5 weeks and 6 months postoperatively.

MAIN OUTCOME MEASURES: Effects of operating method on the psychological wellbeing postoperatively. Analysis of data regarding operating time, peroperative and postoperative complications, blood loss, hospital stay and recovery time.

RESULTS: No significant differences in the scores were observed between the two groups in any of the four psychometric tests. Both the surgical methods were associated with a significantly higher degree of psychological wellbeing 5 weeks postoperatively compared with preoperatively. The operating time was significantly longer for the laparoscopic hysterectomy group, but the duration of the stay in hospital and sick-leave were significantly shorter for laparoscopic hysterectomy group compared with the abdominal hysterectomy group.

CONCLUSIONS: General psychological wellbeing is equal after laparoscopic and abdominal hysterectomy within 6 months after the operation. The advantages of the laparoscopic hysterectomy are the shorter stay in hospital and shorter sick-leave, but these issues must be balanced by a longer duration of the operation.

Emneord
Hysterectomy, multicentre study, psychological wellbeing, psychometry, randomised
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-18472 (URN)10.1111/j.1471-0528.2006.01025.x (DOI)16956334 (PubMedID)
Tilgjengelig fra: 2009-05-28 Laget: 2009-05-28 Sist oppdatert: 2019-06-28bibliografisk kontrollert
2. Factors associated with postoperative recovery after laparoscopic and abdominal hysterectomy
Åpne denne publikasjonen i ny fane eller vindu >>Factors associated with postoperative recovery after laparoscopic and abdominal hysterectomy
2008 (engelsk)Inngår i: European Journal of Obstetrics, Gynecology, and Reproductive Biology, ISSN 0301-2115, E-ISSN 1872-7654, Vol. 140, nr 1, s. 108-113Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

OBJECTIVES: To determine whether the day-by-day recovery of general wellbeing was faster in women undergoing laparoscopic hysterectomy than in total abdominal hysterectomy and to analyse the association between stress coping and sick-leave and the day-by-day recovery measured as general wellbeing.

STUDY DESIGN: A randomised multicentre trial conducted in five hospitals in the South East of Sweden. Hundred and twenty-five women scheduled for hysterectomy for benign conditions were enrolled in the study and 117 women completed the study. Fifty-five women were randomised to abdominal hysterectomy and 62 to laparoscopic hysterectomy. Day-by-day recovery of general wellbeing was measured by a visual analogue scale 1 week preoperatively, 35 days postoperatively, and during 1 week 6 months postoperatively. Stress-coping capability was measured preoperatively using a specific psychometric measurement. Sick-leave was granted with an initial period of 14 days and prolonged on patient demand with 7 days periods. Effects of operating method and stress-coping ability on the day-by-day recovery adjusted for postoperative complications and analgesics were analysed by means of analysis of variance for repeated measurements.

RESULTS: No significant difference was found in the day-by-day recovery of the general wellbeing between the operating methods. Stress-coping ability did significantly influence the day-by-day recovery of general wellbeing. Duration of sick-leave was associated with the occurrence of postoperative complications but not with stress-coping ability.

CONCLUSIONS: The day-by-day recovery of general wellbeing is not faster in laparoscopic hysterectomy than in abdominal hysterectomy. Women with high stress-coping abilities have a better outcome in general wellbeing than women with low stress-coping capacity. Identification of women with low stress-coping abilities and prevention of complications might be of benefit for improving postoperative wellbeing.

HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-18473 (URN)10.1016/j.ejogrb.2008.03.006 (DOI)18456384 (PubMedID)
Tilgjengelig fra: 2009-05-28 Laget: 2009-05-28 Sist oppdatert: 2019-06-28bibliografisk kontrollert
3. A one‐year follow‐up of psychological well‐being after subtotal and total abdominal hysterectomy‐ a randomised study
Åpne denne publikasjonen i ny fane eller vindu >>A one‐year follow‐up of psychological well‐being after subtotal and total abdominal hysterectomy‐ a randomised study
2010 (engelsk)Inngår i: BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, ISSN 1470-0328, Vol. 117, nr 4, s. 479-487Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Objective: To compare subtotal abdominal hysterectomy (SH) and total abdominal hysterectomy (TH) regarding influence on postoperative psychological well‐being and surgical outcome measurements.

Design: A prospective, open, randomised multicenter trial.

Setting: Seven hospitals and one private clinic in the south‐east of Sweden. Population: 200 women scheduled for abdominal hysterectomy for benign conditions were enrolled in the study; 179 women completed the study (94 SH and 85 TH).

Methods: Four different psychometric tests measuring general well‐being, depression and anxiety preoperatively, six and 12 months postoperatively. Statistical analysis of variance and covariance were used. Main outcome measures: Effects of operating method on psychological well‐being postoperatively. Analysis of demographic, clinical and surgical data including peri‐ and postoperative complications and complaints at follow‐up.

Results: No significant differences were observed between the two groups in any of the psychometric tests. Both surgical methods were associated with a significantly higher degree of psychological well‐being six and 12 months postoperatively compared with preoperatively. The operating time was significantly longer for TH than SH. No significant differences were found in the clinical measures including complications. A substantial number of women experienced persistent cyclic vaginal bleedings after SH. Neither minor or major postoperative complications nor serum concentration of sex hormones were associated with the psychological general well‐being 12 months after the operation. Conclusions: General psychological well‐being is equally improved after both SH and TH within 12 months after the operation and does not seem to be associated with occurrence of perioperative complications or serum concentration of sex hormones.

HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-18474 (URN)10.1111/j.1471-0528.2009.02467.x (DOI)000274388200014 ()
Tilgjengelig fra: 2009-05-28 Laget: 2009-05-28 Sist oppdatert: 2019-06-28bibliografisk kontrollert
4. Short‐term recovery after subtotal and total abdominal hysterectomy ‐ a randomised clinical trial
Åpne denne publikasjonen i ny fane eller vindu >>Short‐term recovery after subtotal and total abdominal hysterectomy ‐ a randomised clinical trial
2010 (engelsk)Inngår i: BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, ISSN 1470-0328, Vol. 117, nr 4, s. 469-478Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Objective: To determine whether the day‐byday postoperative recovery differs between women undergoing subtotal and total abdominal hysterectomy and to analyse factors associated with postoperative recovery and sick‐leave.

Design: A prospective, open, randomised multicenter trial.

Setting: Seven hospitals and one private clinic in the south‐east of Sweden.

Population: 200 women scheduled for hysterectomy for benign conditions were enrolled in the study and 178 women completed the study. 94 women were randomised to subtotal abdominal hysterectomy and 84 to total abdominal hysterectomy.

Methods: Day‐by day recovery of general well‐being measured by a visual analogue scale in a diary seven days preoperatively and 35 days postoperatively. Psychometric measurements included depression, anxiety and general psychological well‐being.

Main outcome measures: Effects of operating method and preoperative well‐being on the day‐by‐day recovery and sick‐leave duration.

Results: No significant difference was found in the day‐by‐day recovery between operating methods. Day‐by‐day recovery of general well‐being and duration of sick‐leave was strongly associated with the occurrence of minor complications but not with major complications. The level of psychological wellbeing preoperatively was strongly associated with the day‐by‐day recovery of general wellbeing and duration of sick‐leave.

Conclusions: Day‐by‐day recovery of general well‐being is not faster in subtotal versus total abdominal hysterectomy. Independent of operation method there is an interaction between preoperative psychological wellbeing, postoperative recovery of general wellbeing and duration of sick‐leave. Postoperative complications and preoperative psychological well‐being are strong determinants for duration of sick‐leave. There is a need for intervention studies with focus on complications and preoperative well‐being.

HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-18475 (URN)10.1111/j.1471-0528.2009.02468.x (DOI)000274388200013 ()
Merknad
This is the author's version of the work. It is posted here for personal use, not for redistribution. The definitive version was published: Persson Pär, Jan Brynhildsen and Preben Kjølhede, Short‐term recovery after subtotal and total abdominal hysterectomy ‐ a randomised clinical trial, 2010, BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, (117), 4, 469-478. http://dx.doi.org/10.1111/j.1471-0528.2009.02468.x Copyright: Blackwell Publishing Ltd. Tilgjengelig fra: 2009-05-28 Laget: 2009-05-28 Sist oppdatert: 2019-06-28bibliografisk kontrollert

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