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SHORT-TERM RECOVERY AFTER SUBTOTAL AND TOTAL ABDOMINAL HYSTERECTOMY—A RANDOMISED
CLINICAL TRIALCompiled by:Christine Verina 2013-061-003Vitya Chandika 2013-061-062Priscila Stevanni 2013-061-066
INTRODUCTION
For benign gynecological disorders subtotal abdominal
hysterectomy (SH) has gained popularity compared with
total abdominal hysterectomy (TH) because of a shorter
operating time, less peroperative bleeding and fewer peri-
operative complications.
Aims:
to determine whether the day-by-day postoperative
recovery differed between SH and TH, and to analyze
factors associated with postoperative recovery and sick
leave.
Hypothesis:
SH, because of its presumed less invasive character and
lower complication rate, would give a faster day-by- day
recovery in general wellbeing than TH.
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.
SURGERY
The surgical technique of the hysterectomy was left to the
surgeon’s discretion.
The patient was discharged from the hospital when she
was mobilized and had sufficient pain relief with oral
analgesics.
The patient was contacted regarding general wellbeing
approximately 10 days after discharge and then once
weekly until the patient considered she had recovered.
Patient visited the outpatient clinic after 5 weeks. Data on
postoperative complications and the period of sick leave
were recorded.
Measurement of general well-being• One week before surgery and continuing daily until day 35
postoperatively• Diary concerning their general well-being• Visual analogue scale (VAS) ranging from 0-100• They were asked to report their consumption of
analgesics
Psychological measures• Psychological functioning was measured 1 week
preoperatively by psychometric tests• Psychological General Well-Being (PGWB)
Consists of 22 questions referring to anxiety, depression, wellbeing, self-control, health, and vitality. Rated on a scale 1-6
• Women’s Health Questionnaire (WHQ)Consists of 36 questions referring minor psychological and somatic symptoms experienced by peri- and postmenopausal women. Rated on a scale 1-6
• State Trait Anxiety Inventory (STAI)Consists of 20 statements that evaluate how the respondents feels ‘generally’
• Beck’s Depression Inventory (BDI)Consist of 21 questions. It’s a quantative self-reporting scale for measuring depression and its severity
Statistics• Intention-to-treat principle• Continuous data : t test• Nominal data : Yates corrected Chi square & Fisher’s
exact test• ANOVA repeated measurements was used to compare
the results of general wellbeing and psychological measurements between two groups
• Statistical significance was accepted at the 5% level
RESULTS
RESULTS• The demographic and clinical data did not differ
significantly between two groups• Preoperative data, the operating time was significantly
longer, and prophylactic antibiotics more frequently used in TH than in SH
• No significant differences between two groups in use of parenterally or enterally administered analgesics
Association between day-by-day recovery of general wellbeing and mode of hysterectomy• Day-by-day general wellbeing did not differ significantly
between the hysterectomy groups in the pre and postoperative periods (p=0.9010, p=0.5048)
• There were highly significant main effects over time (p<0.0001) for the pre and postoperative periods
• Postoperative period, a significant interaction effect was observed (p=0.0029)
• The speed of recovery was initially higher for women in SH than TH group, but later on vice versa
Complications after surgery• No complications : 68 (72%) in SH and 64 (76%)
in TH• Major complications : 7 (7,4%) SH and 4 (4,8%) in TH• Minor complications : 19 (20,2%) in SH and 17 (20,2%) in
TH
Factors associated with postoperative recovery day-by-day general wellbeing• Post operative day-by-day wellbeing was strongly
negatively associated with the occurrence of complications (p= 0.0004 main effect between groups, p= 0.0001 main effect over time and no significant reaction)
• There were strong associations with preoperative general wellbeing for all 4 psychometric tests
SICK LEAVE
• The duration of sick leave was also strongly associated
with recovery in terms of day-by-day general wellbeing
postoperatively
• The sick leave was strongly associated with the
occurrence of complications (40 ± 13 days with
complications versus 31 ± 8 days without complications; P
< 0.001).
DISCUSSION
• This study showed no difference in the day-by-day recovery
of self-reported general wellbeing between women
undergoing subtotal or total abdominal hysterectomy
• The use of a VAS to measure general wellbeing may seem
to be a crude method
• In order to detect changes in psychological wellbeing we
used four validated tests: two generic (PQWB and WHQ)
and two specific (STAI and BDI)
• If the sick leave > 35 days the patient was appointed to
visit the doctor in order to be examined and evaluated for
further prolongation of the sick leave, and to receive
treatment if necessary.
• The operation time was statistically significantly longer in
the TH group
• The use of postoperative analgesics was similar in the two
groups
• Psychological wellbeing is of importance for the length of
the recovery period
• In conclusion, the day-by-day recovery of general wellbeing
after SH and TH is equal.
• The occurrence of postoperative complications and a low
preoperative level of psychological wellbeing impair the
postoperative recovery significantly, and prolong the
duration of sick leave.
• Further studies should be encouraged to determine the
impact of intervention strategies on the recovery of women
with low psychological capacity after hysterectomy, efforts
should be made to reduce postoperative complications,