Short‐term recovery after subtotal and total abdominal hysterectomy—a randomised clinical trial

Abstract

Objective To determine whether the day-by-day 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 multicentre trial.Setting Seven hospitals and one private clinic in the south-east of Sweden.Population Two-hundred women scheduled for hysterectomy for benign conditions were enrolled in the study, and 178 women completed the study. Ninety-four women were randomised to subtotal abdominal hysterectomy; 84 women were randomised to total abdominal hysterectomy.Methods The day-by-day recovery of general wellbeing was measured on a visual analogue scale in a diary 7 days preoperatively and 35 days postoperatively. Psychometric measurements included depression, anxiety and general psychological wellbeing.Main outcome measures Effects of operating method and preoperative wellbeing on the day-by-day recovery and duration of sick leave.Results No significant difference was found in the day-by-day recovery between operating methods. The day-by-day recovery of general wellbeing 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 wellbeing is no 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 the duration of sick leave. Postoperative complications and preoperative psychological wellbeing are strong determinants for the duration of sick leave. There is a need for intervention studies with a focus on complications and preoperative wellbeing.Keywords Hysterectomy, randomised study, recovery, subtotal.Please cite this paper as: Persson P, Brynhildsen J, Kjølhede P on behalf of the Hysterectomy Multicentre Study Group in South-East Sweden. Short-term recovery after subtotal and total abdominal hysterectomy-a randomised clinical trial. BJOG 2010;117:469-478.

Pelvic organ prolapse after subtotal and total hysterectomy: a long‐term follow‐up of an open randomised controlled multicentre study

“…[6][7][8] Relatively few randomised trials have compared subtotal abdominal hysterectomy (SH) and total abdominal hysterectomy (TH). [9][10][11][12][13][14][15] In a recently updated meta-analysis no major differences have been shown in physical, including urinary and bowel function, psychological, or sexual outcomes between the two modes. 1 Women are more likely to experience continued cyclical bleeding up to a year after surgery with SH, and because of the preserved cervix the women should be encouraged to continuously and regularly perform check-ups for cervical neoplasia.…”

“…20 We have previously published a randomised trial comparing SH and TH in order to analyse short-term recovery and psychological wellbeing 1 year after surgery. 15,21 Based on the women participating in that randomised trial we aimed to investigate the development of POP subjectively and objectively in the long term. In addition to the information such a study will provide concerning the association between mode of hysterectomy and later development of prolapse, there are quality-of-life and health-economic aspects of this issue to be considered if one of the hysterectomy methods is found to increase the risk of subsequently developing a prolapse that requires surgery.…”

Cost-effectiveness of general anesthesia vs spinal anesthesia in fast-track abdominal benign hysterectomy

“…In addition, sick leave in the SA group was apparently shorter than that usually reported after hysterectomy, which also could reflect the advantages of the enhanced postoperative recovery program 13,24,25 .…”

Hysterectomy: Advances in Perioperative Care

“…Recent advances such as single-port-access laparoscopy techniques may reduce pain scores even further . The extent of surgery (subtotal vs total hysterectomy) does not seem to affect short-term or long-term recovery (Lethaby, 2006;Persson, 2010).…”