BackgroundThere is an ongoing debate regarding the cost-benefit of different surgical modalities for hysterectomy. Studies have relied primarily on evaluation of clinical outcomes and medical expenses. Thus, a paucity of information on patient-reported outcomes including satisfaction, recovery, and recommendations exists.ObjectiveThe objective of this study was to identify differences in patient satisfaction and recommendations by approach to a hysterectomy.MethodsWe recruited a large, geographically diverse group of women who were members of an online hysterectomy support community. US women who had undergone a benign hysterectomy formed this retrospective study cohort. Self-reported characteristics and experiences were compared by surgical modality using chi-square tests. Outcomes over time were assessed with the Jonkheere-Terpstra trend test. Logistic regression identified independent predictors of patient satisfaction and recommendations.ResultsThere were 6262 women who met the study criteria; 41.74% (2614/6262) underwent an abdominal hysterectomy, 10.64% (666/6262) were vaginal, 27.42% (1717/6262) laparoscopic, 18.94% (1186/6262) robotic, and 1.26% (79/6262) single-incision laparoscopic. Most women were at least college educated (56.37%, 3530/6262), and identified as white, non-Hispanic (83.17%, 5208/6262). Abdominal hysterectomy rates decreased from 68.2% (152/223) to 24.4% (75/307), and minimally invasive surgeries increased from 31.8% (71/223) to 75.6% (232/307) between 2001 or prior years and 2013 (P<.001 all trends). Trends in overall patient satisfaction and recommendations showed significant improvement over time (P<.001).There were differences across the surgical modalities in all patient-reported experiences (ie, satisfaction, time to walking, driving and working, and whether patients would recommend or use the same technique again; P<.001). Significantly better outcomes were evident among women who had vaginal, laparoscopic, and robotic procedures than among those who had an abdominal procedure. However, robotic surgery was the only approach that was an independent predictor of better patient experience; these patients were more satisfied overall (odds ratio [OR] 1.31, 95% CI 1.13-1.51) and on six other satisfaction measures, and more likely to recommend (OR 1.64, 95% CI 1.39-1.94) and choose the same modality again (OR 2.07, 95% CI 1.67-2.57). Abdominal hysterectomy patients were more dissatisfied with outcomes after surgery and less likely to recommend (OR 0.36, 95% CI 0.31-0.40) or choose the same technique again (OR 0.29, 95% CI 0.25-0.33). Quicker return to normal activities and surgery after 2007 also were independently associated with better overall satisfaction, willingness to recommend, and to choose the same surgery again.ConclusionsConsistent with other US data, laparoscopic and robotic hysterectomy rates increased over time, with a concomitant decline in abdominal hysterectomy. While inherent shortcomings of this retrospective Web-based study exist, findings show that patient experience...
Welcome to the 19th issue of the journal.This issue is a special issue containing papers from our conference in Durham in July 2012� These include the keynote address from Mary Anne Noone which provided a timely reminder that as well as our concerns with pedagogy and social justice, we cannot afford to neglect the practicalities of ensuring clinic continues to grow and thrive� In this, creating a positive and persuasive brand for our work is an important, and overlooked, issue�The papers in this edition reflect the growing true internationalisation of clinic� The conference had delegates from over 25 countries� We had an unprecedented number of submissions to the journal and I am pleased to report that the papers we publish here are written by clinicians practising in Nigeria, Croatia, the Czech Republic, Australia, India, and New Zealand as well as numerous papers from our colleagues in the UK� As Clinical Legal Education grows around the World we are witnessing the growth in this journal of international colleagues publishing their work�The papers we publish in this issue are of course a small proportion of the papers presented at the 2012 conference� My colleague Christopher Simmonds chaired many of the sessions at the 2012 conference and the remainder of this foreword is given over to his observations on the themes that he identified while attending those sessions�
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