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A one‐year follow‐up of psychological well‐being after subtotal and total abdominal hysterectomy‐ a randomised study
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
2010 (English)In: BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, ISSN 1470-0328, Vol. 117, no 4, 479-487 p.Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
2010. Vol. 117, no 4, 479-487 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-18474DOI: 10.1111/j.1471-0528.2009.02467.xISI: 000274388200014OAI: oai:DiVA.org:liu-18474DiVA: diva2:219733
Available from: 2009-05-28 Created: 2009-05-28 Last updated: 2010-02-22Bibliographically approved
In thesis
1. On the Mode of Hysterectomy: with Emphasis on Recovery and Well‐Being
Open this publication in new window or tab >>On the Mode of Hysterectomy: with Emphasis on Recovery and Well‐Being
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2009. 77 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1104
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-18476 (URN)978‐91‐7393‐687‐3 (ISBN)
Public defence
2009-06-08, Berzeliussalen, Campus US, Linköpings Universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2009-05-28 Created: 2009-05-28 Last updated: 2009-08-21Bibliographically approved

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Persson, PärBrynhildsen, JanKjølhede, Preben

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Obstetrics and gynecology Faculty of Health SciencesDepartment of Gynecology and Obstetrics in Linköping
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