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Brennand EA, Scime NV, Huang B, McDonagh Hull P. Education level is associated with the occurrence and timing of hysterectomy: A cohort study of Canadian women. Acta Obstet Gynecol Scand 2024. [PMID: 39223035 DOI: 10.1111/aogs.14959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 07/22/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Hysterectomy is a common surgery with discernible practice variations that could be influenced by socioeconomic factors. We examined the association between level of educational attainment and the occurrence and timing of hysterectomy in Canadian women. MATERIAL AND METHODS We conducted a prospective cohort study of 30 496 females in the Alberta's Tomorrow Project (2000-2015) followed approximately every 4 years using self-report questionnaires. Educational attainment was defined as high school diploma or less, college degree, university degree (reference group), and postgraduate degree. We used logistic regression analyzing hysterectomy occurrence at any time and before menopause, separately, and flexible parametric survival models analyzing hysterectomy timing with age as the time scale. Multivariable models controlled for race/ethnicity, rural/urban residence, parity, oral contraceptive use, and smoking. RESULTS Overall, 39.1% of females reported a high school diploma or less, 28.9% reported a college degree, 23.5% reported a university degree, and 8.5% reported a postgraduate degree. A graded association was observed between lower education and higher odds of hysterectomy (high school or less: adjusted odds ratio [AOR] 1.68, 95% CI 1.55-1.82; college degree: AOR 1.58, 95% CI 1.45-1.72); results were similar for premenopausal hysterectomy. A graded association between lower education and earlier timing of hysterectomy was also observed up to approximately age 60 (e.g., at age 40: high school or less adjusted hazard ratio [AHR] 1.61, 95% CI 1.49-1.75; college degree AHR 1.53, 95% CI 1.40-1.67). CONCLUSIONS Women with lower levels of education were more likely to experience hysterectomy, including hysterectomy before menopause and at younger ages.
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Affiliation(s)
- Erin A Brennand
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Natalie V Scime
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Beili Huang
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Pauline McDonagh Hull
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Asl FM, Maserat E, Vaezi M, Mohammadzadeh Z. Designing a core data set for benign hysterectomy registration system and its implementation in a referral teaching hospital in Northwest Iran. BMC Pregnancy Childbirth 2024; 24:460. [PMID: 38961444 PMCID: PMC11223272 DOI: 10.1186/s12884-024-06656-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/24/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND AND AIMS Although minimally invasive hysterectomy offers advantages, abdominal hysterectomy remains the predominant surgical method. Creating a standardized dataset and establishing a hysterectomy registry system present opportunities for early interventions in reducing volume and selecting benign hysterectomy methods. This research aims to develop a dataset for designing benign hysterectomy registration system. METHODS Between April and September 2020, a qualitative study was carried out to create a data set for enrolling patients who were candidate for hysterectomy. At this stage, the research team conducted an information needs assessment, relevant data element identification, registry software development, and field testing; Subsequently, a web-based application was designed. In June 2023the registry software was evaluated using data extracted from medical records of patients admitted at Al-Zahra Hospital in Tabriz, Iran. RESULTS During two months, 40 patients with benign hysterectomy were successfully registered. The final dataset for the hysterectomy patient registry comprise 11 main groups, 27 subclasses, and a total of 91 Data elements. Mandatory data and essential reports were defined. Furthermore, a web-based registry system designed and evaluated based on data set and various scenarios. CONCLUSION Creating a hysterectomy registration system is the initial stride toward identifying and registering hysterectomy candidate patients. this system capture information about the procedure techniques, and associated complications. In Iran, this registry can serve as a valuable resource for assessing the quality of care delivered and the distribution of clinical measures.
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Affiliation(s)
- Fatemeh Moghadami Asl
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Daneshgah St, Tabriz, 5165665811, Iran
| | - Elham Maserat
- Department of Medical Informatics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Maryam Vaezi
- Associate professor of Gynecology, Oncology, Department of Obstetrics and Gynecology, Women's Reproductive Health Research Center, Clinical Research Institute, Alzahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zeinab Mohammadzadeh
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Daneshgah St, Tabriz, 5165665811, Iran.
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Baffour Awuah G, Schauberger G, Klug SJ, Tanaka LF. An age-period-cohort analysis of hysterectomy incidence trends in Germany from 2005 to 2019. Sci Rep 2024; 14:15110. [PMID: 38956303 PMCID: PMC11220048 DOI: 10.1038/s41598-024-66019-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 06/26/2024] [Indexed: 07/04/2024] Open
Abstract
Recent studies show declining trends in hysterectomy rates in several countries. The objective of this study was to analyse hysterectomy time trends in Germany over a fifteen-year period using an age-period-cohort approach. Using an ecological study design, inpatient data from Diagnoses Related Group on hysterectomies by subtype performed in Germany from 2005 to 2019 were retrieved from the German Statistical Office. Descriptive time trends and age-period-cohort analyses were then performed. A total of 1,974,836 hysterectomies were performed over the study period. The absolute number of hysterectomies reduced progressively from 155,680 (365 procedures/100,000 women) in 2005 to 101,046 (257 procedures/100,000 women) in 2019. Total and radical hysterectomy decreased by 49.7% and 44.2%, respectively, whilst subtotal hysterectomy increased five-fold. The age-period-cohort analysis revealed highest hysterectomy rates in women aged 45-49 for total and subtotal hysterectomy with 608.63 procedures/100,000 women (95% CI 565.70, 654.82) and 151.30 procedures/100,000 women (95% CI 138.38, 165.44) respectively. Radical hysterectomy peaked later at 65-69 years with a rate of 40.63 procedures/100,000 women (95% CI 38.84, 42.52). The risk of undergoing total or radical hysterectomy decreased over the study period but increased for subtotal hysterectomy. Although, overall hysterectomy rates have declined, subtotal hysterectomy rates have increased; reflecting changes in clinical practice largely influenced by the availability of uterus-sparing options, evolving guidelines and introduction of newer surgical approaches.
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Affiliation(s)
- Gifty Baffour Awuah
- Chair of Epidemiology, TUM School of Medicine and Health, Technical University of Munich, Georg-Brauchle-Ring 56, 80992, Munich, Germany.
| | - Gunther Schauberger
- Chair of Epidemiology, TUM School of Medicine and Health, Technical University of Munich, Georg-Brauchle-Ring 56, 80992, Munich, Germany
| | - Stefanie J Klug
- Chair of Epidemiology, TUM School of Medicine and Health, Technical University of Munich, Georg-Brauchle-Ring 56, 80992, Munich, Germany
| | - Luana Fiengo Tanaka
- Chair of Epidemiology, TUM School of Medicine and Health, Technical University of Munich, Georg-Brauchle-Ring 56, 80992, Munich, Germany
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Bertelsen VM, Tranberg M, Petersen LK, Booth B, Bor P. Improving diagnostic of cervical dysplasia among postmenopausal women aged ≥50 years using local vaginal oestrogen treatment prior to colposcopy: study protocol for a multicentre randomised controlled trial (the IDEAL study). BMJ Open 2024; 14:e082833. [PMID: 38910002 PMCID: PMC11328618 DOI: 10.1136/bmjopen-2023-082833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2024] Open
Abstract
INTRODUCTION Colposcopy is the most important diagnostic tool to detect cervical precancerous lesions and thereby prevention of cervical cancer. Due to age-dependent changes of the cervix, colposcopy is challenging in postmenopausal women, as the majority will have a non-visible transformation zone, resulting in increased risk of missing disease, a diagnostic cone biopsy and prolonged follow-up with repeated colposcopies. This study will be among the first to investigate, if treatment with vaginal oestrogen prior to colposcopy will improve the colposcopy performance, to ensure accurate and timely diagnosis of precancerous cervical lesions among postmenopausal women. METHODS AND ANALYSIS A randomised blinded controlled multicentre study. Enrolment will be performed at gynaecology departments in Central Denmark Region and Region of Southern Denmark. A total of 150 postmenopausal women aged ≥50 years referred for colposcopy due to abnormal cervical screening results will be randomised 1:1 to either pretreatment with vaginal application of Vagifem 30 µg or placebo once a day for 14 days prior to colposcopy. The primary outcome will be to compare the percentage of women in the two groups with a visible transformation zone at colposcopy, and biopsies representative of the transformation zone. Secondary outcomes will be the proportion of detected cervical intraepithelial neoplasia grade 2 or higher in the cervical biopsies; the proportion of diagnostics cone biopsies; the patients' report on possible side effects and compliance to the pretreatment. ETHICS AND DISSEMINATION The study has been approved by the Central Denmark Region Committee on Biomedical Research Ethics (1-10-72-34-22), the Central Denmark Regions' Research Unit (1-16-02-72-22) and The Danish Health Authority (Danish Medicine Agency; 2022015030). The study's EudraCT number is (1-23-456; 2022-000269-42) and it is registered on www. CLINICALTRIALS gov. The local Good Clinical Practice (GCP) unit will supervise and monitor the study closely before, during and after the study period. Findings will be disseminated in peer-reviewed scientific journals and presented in relevant conferences. TRIAL REGISTRATION NUMBER NCT05283421.
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Affiliation(s)
- Vibe Munk Bertelsen
- Department of Gynecology and Obstetrics, Randers Regional Hospital, Randers, Denmark
- University Research Clinic for Cancer Screening and Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mette Tranberg
- University Research Clinic for Cancer Screening and Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Berit Booth
- Department of Gynecology and Obstetrics, Randers Regional Hospital, Randers, Denmark
- Department of Gynecology and Obstetrics, Odense University, Odense, Denmark
| | - Pinar Bor
- Department of Gynecology and Obstetrics, Aarhus University, Aarhus, Denmark
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Cooper NAM, Daniels NF, Magama Z, Aref-Adib M, Odejinmi F. Opportunities for change and levelling up: a trust wide retrospective analysis of 8 years of laparoscopic and abdominal myomectomy. Facts Views Vis Obgyn 2024; 16:195-201. [PMID: 38950533 PMCID: PMC11366112 DOI: 10.52054/fvvo.16.2.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
Background Laparoscopic myomectomy is increasingly considered the gold standard uterine preserving procedure and has well documented benefits over the open approach. Barriers that women have in accessing the most appropriate treatment need to be addressed to ensure optimal patient care and outcomes. Objectives To analyse rates of open and laparoscopic myomectomy at a large NHS trust and identify how many cases could potentially have been performed laparoscopically, and any variation between sites. Materials and Methods A retrospective review of preoperative imaging reports and a surgical database containing information for all myomectomies performed between 1st January 2015 and 31st December 2022. Main outcome measures Number of procedures suitable for alternative surgical approach; length of hospital stay; estimated blood loss; cost differences. Results 846 myomectomies were performed; 656 by laparotomy and 190 by laparoscopy. 194/591 (32.8%) open myomectomies could have been performed laparoscopically and 26/172 (15.1%) laparoscopic myomectomies may have been better performed via an open approach. Length of hospital stay, and estimated blood loss were significantly higher in the open group. Had cases been performed as indicated by pre-operative imaging, the cost differences ranged from -£115,752 to £251,832. Conclusions There is disparity in access to the gold standard care of laparoscopic myomectomy. Due to multifactorial reasons, even at sites where the rate of laparoscopic myomectomy is high, there is still underutilisation of this approach. It is clear that there is scope for change and "levelling up" of this imbalance. What is new? Robust pathways and guidelines must be developed, and more laparoscopic surgeons should be trained to optimise care for women with fibroids.
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Dudukina E, Horváth-Puhó E, Sørensen HT, Ehrenstein V. Association between vaginal bleeding in pregnancy that resulted in delivery and risk of cancer: A Danish registry-based cohort study. Paediatr Perinat Epidemiol 2024; 38:330-342. [PMID: 37580881 DOI: 10.1111/ppe.13001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 07/17/2023] [Accepted: 07/28/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Vaginal bleeding (VB) before 20 gestational weeks of a viable pregnancy is a manifestation of a threatened miscarriage. VB is associated with increased levels of pro-inflammatory cytokines such as interferon-gamma, tumour necrosis factor-alpha and interleukin-6. Increased levels of these cytokines and oxidative stress are risk factors for cancer. The risk of cancer following a VB-affected pregnancy that ended in childbirth is unknown. OBJECTIVES To investigate the associations between VB in pregnancy that resulted in delivery and risk of incident cancer. METHODS We conducted a cohort study (1995-2018) in Denmark using administrative and healthcare registries. We included 37,082 VB-affected deliveries, 1,363,614 VB-unaffected deliveries, 324,328 pregnancies ending in terminations, and 137,104 miscarriages. We computed the absolute risk of cancer and hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, calendar year, morbidities, and socio-economic factors using Cox proportional hazards regression. Multiple pregnancies to the same woman were accounted for in the analysis. RESULTS The median (25th-75th percentile) follow-up in the study was 12.6 (6.9, 18.2) years. The prevalence of VB in the present study was 3%. At the end of the follow-up, there were 1320 cancer cases among the VB-affected delivery cohort, 40,420 among the VB-unaffected delivery cohort, 10,300 among the termination cohort and 4790 among the miscarriage cohort. HRs for any cancer among VB-affected deliveries were 1.03 (95% CI 0.97, 1.08) compared with VB-unaffected deliveries, 1.03 (95% CI 0.97, 1.09) compared with terminations and 0.90 (95% CI 0.84, 0.95) compared with miscarriages. There were no increased risks of premenopausal breast cancer, cervical cancer, ovary and fallopian tube cancer or uterine cancer following VB-affected deliveries vs. comparison cohorts. CONCLUSIONS We found no evidence of an association between vaginal bleeding in pregnancy and an increased risk of cancer.
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Affiliation(s)
- Elena Dudukina
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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Krentel H, Naem A, Moawad G, De Wilde RL. Robotic-assisted total hysterectomy with transilluminating uterine manipulator - The guiding green light of the firefly mode. Asian J Surg 2024:S1015-9584(24)00682-1. [PMID: 38643055 DOI: 10.1016/j.asjsur.2024.03.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/22/2024] [Indexed: 04/22/2024] Open
Affiliation(s)
- Harald Krentel
- Department of Obstetrics, Gynecology, Gynecologic Oncology, and Senology, Bethesda Hospital Duisburg, 47053, Duisburg, Germany.
| | - Antoine Naem
- Department of Obstetrics, Gynecology, Gynecologic Oncology, and Senology, Bethesda Hospital Duisburg, 47053, Duisburg, Germany; Faculty of Mathematics and Computer Science, University of Bremen, 28359, Bremen, Germany.
| | - Gaby Moawad
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC, 20037, USA; The Center for Endometriosis and Advanced Pelvic Surgery, Washington, DC, 22101, USA.
| | - Rudy Leon De Wilde
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, 26121, Oldenburg, Germany.
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Kemah BL, Bhagat N, Pandya A, Sullivan R, Sundar SS. Training the gynecologic oncologists of the future - challenges and opportunities. Int J Gynecol Cancer 2024; 34:619-626. [PMID: 37989477 DOI: 10.1136/ijgc-2023-004557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
Several recent advances in gynecologic cancer care have improved patient outcomes. These include national screening and vaccination programs for cervical cancer as well as neoadjuvant chemotherapy for ovarian cancer. Conversely, these advances have cumulatively reduced surgical opportunities for training creating a need to supplement existing training strategies with evidence-based adjuncts. Technologies such as virtual reality and augmented reality, if properly evaluated and validated, have transformative potential to support training. Given the changing landscape of surgical training in gynecologic oncology, we were keen to summarize the evidence underpinning current training in gynecologic oncology.In this review, we undertook a literature search of Medline, Google, Google Scholar, Embase and Scopus to gather evidence on the current state of training in gynecologic oncology and to highlight existing evidence on the best methods to teach surgical skills. Drawing from the experiences of other surgical specialties we examined the use of training adjuncts such as cadaveric dissection, animation and 3D models as well as simulation training in surgical skills acquisition. Specifically, we looked at the use of training adjuncts in gynecologic oncology training as well as the evidence behind simulation training modalities such as low fidelity box trainers, virtual and augmented reality simulation in laparoscopic training. Finally, we provided context by looking at how training curriculums varied internationally.Whereas some evidence to the reliability and validity of simulation training exists in other surgical specialties, our literature review did not find such evidence in gynecologic oncology. It is important that well conducted trials are used to ascertain the utility of simulation training modalities before integrating them into training curricula.
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Affiliation(s)
- Ben-Lawrence Kemah
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- Department of Health Research, Health Education and Research Organisation (HERO), Buea, Cameroon
| | - Nanak Bhagat
- Department of Gynaecological Oncology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Aayushi Pandya
- Department of Obstetrics and Gynaecology, Barts Health NHS Trust, London, UK
| | - Richard Sullivan
- Department of Cancer and Global Health, King's College London, London, UK
| | - Sudha S Sundar
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Pan Birmingham Gynaecological Cancer Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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Johannesson U, Amato M, Forsgren C. Pelvic floor and sexual function 3 years after hysterectomy - A prospective cohort study. Acta Obstet Gynecol Scand 2024; 103:580-589. [PMID: 38071460 PMCID: PMC10867362 DOI: 10.1111/aogs.14751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/17/2023] [Accepted: 11/23/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Long term effects after hysterectomy, such as a worsening of pelvic floor and sexual function, have been studied with diverse results. Therefore, we investigated the long-term effects of hysterectomy for benign indication on pelvic floor and sexual function as well as differences in outcome depending on mode of hysterectomy. MATERIAL AND METHODS In a prospective clinical cohort study, we included 260 women scheduled for hysterectomy who answered validated questionnaires; pelvic floor impact questionnaire (PFIQ-7), pelvic floor distress inventory (PFDI-20) and female sexual function index (FSFI). Participants were followed up to 3 years after surgery. Nonparametric statistics and mixed effect models were used in analyses of the data. RESULTS After exclusions, 242 women remained in the study, with a response rate at the 3-year follow-up of 154/242 (63.6%) for all questionnaires. There was an improvement of pelvic floor function with a mean score of PFIQ-7 at baseline of 42.5 (SD 51.7) and at 3 years 22.7 (SD 49.4), (p < 0.001) and mean score of PFDI-20 at baseline was 69.6 (SD 51.1) and at 3 years 56.2 (SD 54.6), (p = 0.001). A deterioration of sexual function was seen among the sexually active women after 3 years with a mean score of FSFI at baseline 25.2 (SD 6.6) and after 3 years 21.6 (SD 10.1), (p < 0.001). However, this was not consistent with the unaltered sexual function for the whole cohort. No difference in pelvic floor or sexual function was detected when comparing robotic assisted laparoscopic hysterectomy, laparoscopic hysterectomy and abdominal hysterectomy. CONCLUSIONS Three years after surgery robotic assisted laparoscopic hysterectomy, total laparoscopic hysterectomy and abdominal hysterectomy improve pelvic floor function to the same extent. Among the sexually active women, a decline of sexual function was seen after 3 years, not consistent with the entire cohort and independent of surgical methods. Whether this is a trend associated with aging or menopausal transition remains to be studied.
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Affiliation(s)
- Ulrika Johannesson
- Department of Clinical SciencesDanderyd Hospital, Karolinska InstitutetStockholmSweden
- Department of Obstetrics and GynecologyDanderyd HospitalStockholmSweden
| | - Martina Amato
- Department of Clinical SciencesDanderyd Hospital, Karolinska InstitutetStockholmSweden
- Department of Obstetrics and GynecologyDanderyd HospitalStockholmSweden
| | - Catharina Forsgren
- Department of Clinical SciencesDanderyd Hospital, Karolinska InstitutetStockholmSweden
- Department of Obstetrics and GynecologyDanderyd HospitalStockholmSweden
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Turan A, Karabayır HB, Kaya İG. Examining the changes in women's lives after the hysterectomy operation: Experiences of women from Turkey. Arch Womens Ment Health 2024:10.1007/s00737-024-01419-3. [PMID: 38183419 DOI: 10.1007/s00737-024-01419-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 01/02/2024] [Indexed: 01/08/2024]
Abstract
PURPOSE The aim of the study is to examine what kind of changes the operation has brought about in the social and psychological life of women. METHODS The study was a hermeneutic-phenomenological research conducted using qualitative research methods. It took place between May and July 2023 at a university hospital located in Istanbul, Turkey. Following ethical approval, the study included a total of 24 women who had undergone a 'total abdominal hysterectomy, bilateral salpingo-oophorectomy.' These participants were selected using a combination of maximum diversity sampling and random sampling methods. Data collection was carried out using a semi-structured interview form. The interviews were conducted using face-to-face interview techniques and in-depth interview methods. Qualitative data analysis involved using the coding paradigm of Grounded Theory and Straus and Corbin's coding framework. For the analysis of quantitative data, SPSS version 28.0 was employed, while qualitative data were analyzed using MaxQDA Analytics Pro 2022. RESULTS The study found that the participants had a mean age of 47 ± 7.53, and the majority, 66.7%, had not reached menopause before the operation. The qualitative analysis of the semi-structured interviews revealed five main themes, which were identified as follows: 'hysterectomy experiences', 'the impact of hysterectomy on sexual life', 'the significance attributed to the uterus', 'the significance attributed to femininity', and 'self-efficacy after hysterectomy'. CONCLUSIONS The study revealed that women experienced changes in self-perception, body image, a sense of organ loss, and developed negative attitudes towards menopause following a hysterectomy. Additionally, there was a noticeable connection between the meanings attributed to the uterus and femininity, which was often influenced by cultural and social factors. In light of these findings, it is recommended that women receive counseling from healthcare professionals before undergoing a hysterectomy. This guidance can help women better understand and cope with the physical, emotional, and cultural aspects of the procedure.
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Affiliation(s)
- Ayşenur Turan
- Department of Midwifery, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Turkey.
| | - Hilal Başak Karabayır
- Department of Midwifery, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - İffet Güler Kaya
- Department of Midwifery, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
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Chang DH, Dumanski SM, Brennand EA, Ruzycki SM, Ramage K, Gantar T, Shah S, Ahmed SB. Female Reproductive Health and Contraception Use in CKD: An International Mixed-Methods Study. Kidney Med 2023; 5:100713. [PMID: 37719717 PMCID: PMC10502408 DOI: 10.1016/j.xkme.2023.100713] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Rationale & Objective Female reproductive health is recognized as a predictor of morbidity, mortality, and quality of life, although data in the setting of chronic kidney disease (CKD) are limited. Study Design A mixed-methods study was employed. Phase 1 was an anonymous, internet-based survey. Phase 2 was semistructured interviews offered to all respondents upon survey completion. Setting & Participants The survey was disseminated internationally from October 4, 2021, to January 7, 2022, to individuals aged 18-50 years with both a uterus and CKD diagnosis. Outcomes Menstrual health and contraceptive use by CKD stage (dialysis, nondialysis CKD, and transplant). Analytical Approach Survey data were analyzed using descriptive statistics. Interview data were analyzed using the framework method of analysis. Results Of 152 respondents, 98 (mean age 33 ± 0.7 years; n = 20 dialysis, n = 59 nondialysis CKD, n = 19 transplant) satisfied the inclusion criteria, representing 3 continents. The most common causes of CKD among survey respondents were hereditary causes in dialysis (n = 6, 30%) and glomerulonephritis in nondialysis CKD (n = 22, 37%) and transplant (n = 6, 32%). The majority reported heavy menstrual bleeding (n = 12, 86% dialysis; n = 46, 94% nondialysis CKD; n = 14, 100% transplant). Less than half of participants were consistently able to afford period products. Condoms were the most common contraceptive reported. Most participants reported no contraceptive use (n = 10, 50% dialysis; n = 37, 63% nondialysis CKD; n = 7, 37% transplant), primarily because of "fear". Interviews (n = 6) revealed a perception of a relationship between kidney function and menstrual health, concerns about contraceptive use, and a desire for greater multidisciplinary care to improve kidney and reproductive health. Limitations Self-reported outcomes, need for internet access and a device. Conclusions Abnormal menstruation and period poverty (ie, inability to afford period products and the socioeconomic consequences of menstruation) were common, and contraceptive use was low among female individuals with CKD, highlighting an important gap in the sex-specific care of this population. Plain-Language Summary Chronic kidney disease (CKD) in female individuals is accompanied by menstrual disorders and low contraceptive use. However, most data are limited to the dialysis and transplant populations. Therefore, this mixed-methods study aimed to describe self-assessed menstruation and contraceptive use across all stages of CKD. People aged 18-50 years with a uterus and CKD diagnosis were invited to participate in an online survey shared internationally as well as an optional telephone interview. Abnormal menstruation and period poverty (ie, inability to afford period products and the socioeconomic consequences of menstruation) were common, and contraceptive use was low among female individuals with CKD, highlighting an important gap in the sex-specific care of this population.
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Affiliation(s)
- Danica H. Chang
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Sandra M. Dumanski
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
- Alberta Kidney Disease Network, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Erin A. Brennand
- Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Shannon M. Ruzycki
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Kaylee Ramage
- Department of Obstetrics and Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Taryn Gantar
- Kidney Health Strategic Clinical Network, Alberta, Canada
| | - Silvi Shah
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
| | - Sofia B. Ahmed
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
- Alberta Kidney Disease Network, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Calgary, Alberta, Canada
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12
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Isoyama K, Matsuura M, Hayasaka M, Nagao S, Nishimura Y, Yoshioka T, Imai Y, Miyagi E, Suzuki Y, Saito T. Nationwide trends in and regional factors associated with minimally invasive hysterectomy for benign indications in Japan. Eur J Obstet Gynecol Reprod Biol 2023; 289:129-135. [PMID: 37660507 DOI: 10.1016/j.ejogrb.2023.08.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/18/2023] [Accepted: 08/28/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE To examine the prevalence trends of minimally invasive hysterectomy for benign indications in Japan and investigate regional disparities. STUDY DESIGN A retrospective cohort and ecological study using "The National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data". SETTING Nationwide Japan. PATIENTS Individuals who underwent hysterectomy for benign indications from 2014 to 2020. INTERVENTIONS Trend analysis of minimally invasive surgery (MIS) rates through laparoscopic hysterectomies (LH) and robotic-assisted laparoscopic hysterectomies (RA-LH) at the national and prefecture levels. Examination of regional factors contributing to the disparity in MIS implementation rates by second medical service area (SMSA). RESULTS The number of LH has increased from 16,016 in 2014 to 27,755 in 2020. The nationwide MIS hysterectomy rate increased from 29% in 2014 to 55% in 2020 (p less than 0.001). More than 50% of hysterectomies have been performed as MIS since 2019. There was an increasing trend in MIS rates in all age groups. All prefectures except one showed a significant upward trend (p less than 0.05) in the MIS rates, but MIS rates varied widely (23-84%). In a multivariable model, the MIS was more likely to be performed in the SMSAs in western Japan (p = 0.011), in the SMSAs where the number of laparoscopy-qualified gynecologists is 5-10 (p = 0.013), and 11 or higher (p less than 0.001). CONCLUSIONS This study reveals a shift towards minimally invasive surgery (MIS) in total hysterectomy procedures in Japan. However, significant disparities in the prevalence of MIS hysterectomy exist, potentially influenced by the number of laparoscopy-qualified gynecologists.
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Affiliation(s)
- Kyoko Isoyama
- Department of Gynecology, Sapporo Medical University, 291, West 16, South 1, Chuo-Ku, Sapporo, Hokkaido 060-8543, Japan
| | - Motoki Matsuura
- Department of Gynecology, Sapporo Medical University, 291, West 16, South 1, Chuo-Ku, Sapporo, Hokkaido 060-8543, Japan.
| | - Misa Hayasaka
- Department of Obstetrics and Gynecology, Asahikawa Medical University, Midorigaokahigashi 2-1-1-1, Asahikawa, Hokkaido 078-8510, Japan
| | - Sachiko Nagao
- Department of Gynecology, Sapporo Medical University, 291, West 16, South 1, Chuo-Ku, Sapporo, Hokkaido 060-8543, Japan
| | - Yoko Nishimura
- Department of Gynecology, Sapporo Medical University, 291, West 16, South 1, Chuo-Ku, Sapporo, Hokkaido 060-8543, Japan
| | - Toshiki Yoshioka
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004, Kanagawa, Japan
| | - Yuichi Imai
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004, Kanagawa, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama 236-0004, Kanagawa, Japan
| | - Yukio Suzuki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
| | - Tsuyoshi Saito
- Department of Gynecology, Sapporo Medical University, 291, West 16, South 1, Chuo-Ku, Sapporo, Hokkaido 060-8543, Japan
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13
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Casarin J, Ghezzi F, Mueller M, Ceccaroni M, Papadia A, Ferreira H, Uccella S, Malzoni M, Mabrouk M, Seracchioli R, Bordi G, Gisone BE, Vaineau C, Bogani G, Roviglione G, Arena A, Ambrosoli AL, Graf C, Bruni F, Bras R, Falcone F, Raimondo D, Giovanni AD, Cromi A. Surgical Outcomes and Complications of Laparoscopic Hysterectomy for Endometriosis: a multicentric cohort study. J Minim Invasive Gynecol 2023:S1553-4650(23)00126-7. [PMID: 37004810 DOI: 10.1016/j.jmig.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/22/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023]
Abstract
STUDY OBJECTIVE To investigate the postoperative morbidity of laparoscopic hysterectomy (LH) for endometriosis/adenomyosis in terms of operative outcomes and complications. DESIGN Retrospective multicentric cohort study. SETTING Eight European minimally invasive referral centers. PATIENTS Data from 995 patients with pathologically confirmed endometriosis and/or adenomyosis who underwent LH without concomitant urological and/or gastroenterological procedures from January 2010 to December 2020. INTERVENTIONS Total laparoscopic hysterectomy. MEASUREMENTS AND MAIN RESULTS Demographic patients' characteristics, surgical outcomes, and intraoperative and postoperative complications were evaluated. We considered major postoperative surgical-related complications any grade 2 or more events (Clavien-Dindo score) that occurred within 30 days from surgery. Univariate analysis and multivariable models fit with logistic regression were used to estimate the adjusted odds ratio (OR) and corresponding 95% CI for major complications. Median age at surgery was 44 years (28-54) and about half of them (505, 50.7%) were on medical treatment (estro-progestins, progestin or GnRh-analogues) at the time of surgery. In association with LH, posterior adhesiolysis was performed in 387 (38,9%) cases and deep nodule resection in 302 (30,0%). Intraoperative complications occurred in 3% of the patients and major postoperative complications were registered in 93 (9.3%). The multivariable analysis showed an inverse correlation between the occurrence of Clavien-Dindo >2 complications and age (OR 0.94, 95%CI 0.90-0.99), while previous surgery for endometriosis (OR 1.62, 95%CI 1.01-2.60) and intraoperative complications (OR 6.49, 95%CI 2.65-16.87) were found as predictors of major events. Medical treatment at the time of surgery has emerged as a protective factor (OR 0.50, 95%CI 0.31-0.81). CONCLUSION LH for endometriosis/adenomyosis is associated with non-negligible morbidity. Knowing the factors associated with higher risks of complications might be used for risk stratification and could help clinicians during preoperative counseling. The administration of estro-progestin or progesterone preoperatively might reduce the risks of postoperative complications following surgery.
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14
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Olah KSJ. Minimal efforts to adopt minimally invasive techniques: Is gynaecology falling behind? BJOG 2023; 130:244-246. [PMID: 36156352 DOI: 10.1111/1471-0528.17298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 08/07/2022] [Accepted: 08/22/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Karl S J Olah
- South Warwickshire NHS Trust, Warwick Hospital, Warwick, UK
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15
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Moufawad G, Laganà AS, Habib N, Chiantera V, Giannini A, Ferrari F, Vitagliano A, Della Corte L, Bifulco G, Sleiman Z. Learning Laparoscopic Radical Hysterectomy: Are We Facing an Emerging Situation? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20032053. [PMID: 36767419 PMCID: PMC9915887 DOI: 10.3390/ijerph20032053] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 05/29/2023]
Abstract
Despite wide screening campaigns and early detection, cervical cancer remains the fourth most common cancer among women. Radical hysterectomy, whether by open, laparoscopic or by robotic-assisted techniques, is the mainstay treatment. However, for adequate surgical results and good oncological prognosis, a gynecological surgeon should be trained to perform those procedures. The learning curve of radical hysterectomy, especially by laparoscopy, is influenced by several factors. The LACC trial, the decrease in cervical cancer incidence and radical hysterectomy procedures have widely reduced the learning curve for surgeons. This article mainly discusses the learning curve of laparoscopic radical hysterectomy for cervical cancers, and how several factors are influencing it negatively, with the need to have medical authorities reset specific surgical training programs and allocate them to special oncological centers.
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Affiliation(s)
- Graziella Moufawad
- Department of Obstetrics and Gynecology, Lebanese American University Medical Center-Rizk Hospital, Beirut 1100, Lebanon
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Nassir Habib
- Obstetrics and Gynecology Department, Francois Quesnay Hospital, 78200 Mantes-La-Jolie, France
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Andrea Giannini
- Department of Medical and Surgical Sciences and Translational Medicine, PhD Course in “Translational Medicine and Oncology”, Sapienza University, 00185 Rome, Italy
| | - Federico Ferrari
- Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
- Division of Obstetrics and Gynecology, ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Amerigo Vitagliano
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncologic Science, University of Bari, 70100 Bari, Italy
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, 80138 Naples, Italy
| | - Giuseppe Bifulco
- Department of Public Health, University of Naples Federico II, 80138 Naples, Italy
| | - Zaki Sleiman
- Department of Obstetrics and Gynecology, Lebanese American University Medical Center-Rizk Hospital, Beirut 1100, Lebanon
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Sakko Y, Aimagambetova G, Terzic M, Ukybassova T, Bapayeva G, Gusmanov A, Zhakhina G, Zhantuyakova A, Gaipov A. The Prevalence, Indications, Outcomes of the Most Common Major Gynecological Surgeries in Kazakhstan and Recommendations for Potential Improvements into Public Health and Clinical Practice: Analysis of the National Electronic Healthcare System (2014-2019). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14679. [PMID: 36429398 PMCID: PMC9690357 DOI: 10.3390/ijerph192214679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Major gynecological surgeries are indicated for the treatment of female genital pathologies. It is key to examine trends in gynecologic surgical procedures and updated recommendations by international gynecological societies to find opportunities for improvement of local guidelines. To date, a very limited number of reports have been published on the epidemiology of gynecological surgeries in Kazakhstan. Moreover, some local guidelines for gynecological conditions do not comply with the international recommendations. Thus, this study aims to investigate the prevalence, indications, and outcomes of the most common major gynecological surgeries by analyzing large-scale Kazakhstani healthcare data, and identifying possible opportunities for improvement of the local public health and clinical practice. METHODS A descriptive, population-based study among women who underwent a gynecological surgery in healthcare settings across the Republic of Kazakhstan during the period of 2014-2019 was performed. Data were collected from the Unified Nationwide Electronic Health System (UNEHS). RESULTS In total, 80,401 surgery cases were identified and analyzed in the UNEHS database for a period of 6 years (2014-2019). The median age of the participants was 40 years old, with 61.1% in reproductive age. The most prevalent intervention was a unilateral salpingectomy-29.4%, with 72.6% patients aged between 18-34 years. The proportion of different types of hysterectomies was 49.4%. In 20% of cases, subtotal abdominal hysterectomy was performed due to uterine leiomyoma. The proportion of laparoscopic procedures in Kazakhstani gynecological practice is as low-11.59%. CONCLUSIONS The Kazakhstani public health and gynecological care sector should reinforce implementation of contemporary treatment methods and up-to-date policies and guidelines. The overall trends in surgical procedures performed for gynecological pathologies, including uterine leiomyoma and ectopic pregnancy treatment, should be changed in favor of the minimally invasive methods in order to adopt a fertility-sparing approach.
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Affiliation(s)
- Yesbolat Sakko
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
| | - Gulzhanat Aimagambetova
- Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
| | - Milan Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
- Clinical Academic Department of Women’s Health, CF “University Medical Center”, Astana 010000, Kazakhstan
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA 15213, USA
| | - Talshyn Ukybassova
- Clinical Academic Department of Women’s Health, CF “University Medical Center”, Astana 010000, Kazakhstan
| | - Gauri Bapayeva
- Clinical Academic Department of Women’s Health, CF “University Medical Center”, Astana 010000, Kazakhstan
| | - Arnur Gusmanov
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
| | - Gulnur Zhakhina
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
| | - Almira Zhantuyakova
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Abduzhappar Gaipov
- Department of Medicine, School of Medicine, Nazarbayev University, Astana 010000, Kazakhstan
- Clinical Academic Department of Internal Medicine, CF “University Medical Center”, Astana 010000, Kazakhstan
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17
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Quantifying the Added Value of 2 Common Frailty Measures for Predicting Adverse Outcomes After Elective Hysterectomy. Female Pelvic Med Reconstr Surg 2022; 28:526-532. [PMID: 35543546 DOI: 10.1097/spv.0000000000001198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IMPORTANCE Although frailty is predictive of adverse outcomes in predominantly male general and orthopedic surgical populations, the utility of American College of Surgeons National Surgical Quality Improvement Program-based frailty measurement for hysterectomy is unclear. OBJECTIVES The objective of this study was to measure the added contribution of the modified frailty index (mFI) and Risk Analysis Index (RAI) for predicting adverse outcomes after hysterectomy. STUDY DESIGN A secondary analysis of the 2011 to 2014 American College of Surgeons National Surgical Quality Improvement database was conducted. Benign elective hysterectomy by any route was included. The primary outcome was readmission within 30 days of surgery. Secondary outcomes were major (Clavien-Dindo grade ≥3) and minor (grade 1-2) complications. The fraction of new prognostic information attributable to each frailty measure was estimated by the ratio of model likelihood-ratio χ 2 values compared with a baseline model, including American Society of Anesthesiologists classification, age, body mass index (BMI), smoking status, and surgical route. RESULTS Among 70,649 cases, 3.0% (95% confidence interval [CI], 2.9-3.1) were readmitted within 30 days and 2.8% (95% CI, 2.7-2.9) and 5.2% (95% CI, 5.0-5.4) had major and minor complications, respectively. The RAI provided a greater fraction of new prognostic information than the mFI when predicting readmission (4.8 vs 2.7%) and major complications (4.8 vs 2.3%). Interaction analysis showed a stronger association of frailty and outcomes among individuals undergoing abdominal hysterectomy and with BMI of 40 of higher or less than 20. CONCLUSIONS The RAI and mFI provided modest improvement in the ability to predict adverse outcomes, which limits its clinical utility. Surgeons may consider selective utilization among those individuals undergoing abdominal hysterectomy or with BMI of 40 of higher or less than 20.
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18
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Brunes M, Ek M, Drca A, Söderberg M, Bergman I, Warnqvist A, Johannesson U. Vaginal vault prolapse and recurrent surgery: A nationwide observational cohort study. Acta Obstet Gynecol Scand 2022; 101:542-549. [PMID: 35238023 DOI: 10.1111/aogs.14341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/29/2022] [Accepted: 02/15/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In surgical repair of pelvic organ prolapse the recurrence rate is about 30% and the importance of apical support was recently highlighted. In surgical randomized controlled studies, the external validity can be compromised because the surgical outcomes often depend on surgical volume. Therefore, we sought to study outcomes of surgical treatment in patients with vaginal vault prolapse in a nationwide setting with a variety of surgical volumes. MATERIAL AND METHODS This is a nationwide cohort study. All patients with a vaginal vault prolapse undergoing surgery, between January 1, 2015 and December 31, 2018, were identified from the Swedish National Quality Register of Gynecological Surgery, GynOp. The primary outcome was the frequency of recurrent pelvic organ prolapse surgery within 2 years postoperatively. Secondary outcomes included patient-reported vaginal bulging, operative time, estimated blood loss and 1-year postoperative complications. RESULTS In 1812 patients with vaginal vault prolapse, 538 (30%) had a sacrospinous ligament fixation (SSLF) with graft, 441 (24%) underwent SSLF without graft, and 200 (11%) underwent minimally invasive sacrocolpopexy (SCP) or sacrocervicopexy (SCerP). A significantly higher proportion of patients undergoing recurrent pelvic organ prolapse surgery was seen in SSLF without graft than in SSLF with graft (adjusted odds ratio [aOR] 2.2, 95% CI 1.4-3.6). Patient-reported sensation of vaginal bulging 1 year after surgery was higher in the SSLF group without graft than in the SSLF group with graft (aOR 1.9, 95% CI 1.3-2.8) and in the SCP/SCerP group (aOR 2.0, 95% CI 1.1-3.4). Finally, we found a significantly higher rate of complications 1 year after surgery in SSLF without graft (aOR 2.3, 95% CI 1.2-4.2) and in SSLF with graft (aOR 2.2, 95% CI 1.2-4.2) compared with SCP/SCerP. CONCLUSIONS In patients with vaginal vault prolapse, SSLF without graft was associated with a higher frequency of recurrent pelvic organ prolapse surgery compared with SSLF with graft, and a higher subjective relapse rate compared with SCP/SCerP and SSLF with graft. Additionally, the complication rate 1 year after primary surgery was higher in SSLF both with and without graft than in SCP/SCerP.
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Affiliation(s)
- Malin Brunes
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Division of Obstetrics and Gynecology at Södersjukhuset, Stockholm, Sweden
| | - Marion Ek
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Division of Obstetrics and Gynecology at Södersjukhuset, Stockholm, Sweden
| | - Anna Drca
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Division of Obstetrics and Gynecology at Södersjukhuset, Stockholm, Sweden
| | - Marie Söderberg
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Division of Obstetrics and Gynecology at Södersjukhuset, Stockholm, Sweden
| | - Ida Bergman
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Division of Obstetrics and Gynecology at Södersjukhuset, Stockholm, Sweden
| | | | - Ulrika Johannesson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Division of Obstetrics and Gynecology at Danderyd Hospital, Stockholm, Sweden
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19
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Bräuner EV, Wilson LF, Koch T, Christensen J, Dehlendorff C, Duun-Henriksen AK, Priskorn L, Abildgaard J, Simonsen MK, Jørgensen JT, Lim YH, Andersen ZJ, Juul A, Hickey M. The long-term association between bilateral oophorectomy and depression: a prospective cohort study. Menopause 2022; 29:276-283. [PMID: 35213515 DOI: 10.1097/gme.0000000000001913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Depression is a leading cause of disability globally and affects more women than men. Ovarian sex steroids are thought to modify depression risk in women and interventions such as bilateral oophorectomy that permanently change the sex steroid milieu may increase the risk of depression. This study aimed to investigate the associations between unilateral and bilateral oophorectomy and depression over a 25-year period (1993-2018) and whether this varied by age at oophorectomy or use of menopausal hormone therapy. METHODS Twenty-five thousand one hundred eighty-eight nurses aged ≥45 years from the Danish Nurse Cohort were included. Nurses with depression prior to baseline were excluded. Poisson regression models, with log-transformed person-years as offset, were used to assess the associations between oophorectomy and incident depression. Nurses who retained their ovaries were the reference group. RESULTS Compared with nurses with retained ovaries, bilateral oophorectomy was associated with a slightly higher rate of depression (rate ratio [RR], 1.08; 95% confidence interval [CI], 0.95-1.23), but without statistical significance. However, when stratified by age at oophorectomy, compared with nurses with retained ovaries, bilateral oophorectomy at age ≥51 years was associated with higher rates of depression (RR 1.16; 95% CI, 1.00-1.34), but not bilateral oophorectomy at age <51 years (RR 0.86; 95% CI, 0.69-1.07); P value for difference in estimates = 0.02. No association between unilateral oophorectomy and depression was observed. CONCLUSIONS In this cohort of Danish female nurses, bilateral oophorectomy at age ≥51 years, but not at younger ages, was associated with a slightly higher rate of depression compared with those who retained their ovaries.
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Affiliation(s)
- Elvira V Bräuner
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Louise F Wilson
- NHMRC Centre for Research Excellence on Women and Non-communicable Diseases (CREWaND), School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Trine Koch
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jane Christensen
- Statistics and Data Analysis, Danish Cancer Society, Copenhagen, Denmark
| | | | | | - Lærke Priskorn
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Julie Abildgaard
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mette K Simonsen
- Department of Neurology and Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Jeanette T Jørgensen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Zorana J Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anders Juul
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- The International Research and Research Training Centre in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Martha Hickey
- Department of Obstetrics and Gynaecology, University of Melbourne and the Royal Women's Hospital, Melbourne, Victoria, Australia
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20
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Scime NV, Brown HK, Metcalfe A, Brennand EA. Prevalence of Hysterectomy by Self-Reported Disability Among Canadian Women: Findings from a National Cross-Sectional Survey. WOMEN'S HEALTH REPORTS 2021; 2:557-565. [PMID: 34909762 PMCID: PMC8665278 DOI: 10.1089/whr.2021.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/25/2022]
Abstract
Introduction: Our objective was to investigate differences in prevalence of hysterectomy by self-reported disability status among Canadian women. Materials and Methods: We analyzed cross-sectional data from the Canadian Community Health Survey 2012 on 30,170 women aged ≥20 years. Disability was defined as reports of sometimes or often (vs. never) experiencing functional limitations or reduction in daily activities at home, school, or work. Frequency of these limitations was used as a proxy for disability severity. The outcome was self-reported hysterectomy status. Modified Poisson regression was used to quantify the prevalence ratio (PR) and 95% confidence interval (CI) for hysterectomy according to any, functional, or activity-limiting disability, after adjustment for household income, employment, education, ethnicity, and marital status. Results were stratified by age at time of data collection, categorized as childbearing (20–44 years), perimenopausal (45–59 years), and postmenopausal (60 years and older). Results: Disability was significantly and consistently associated with higher prevalence of hysterectomy in women. The strength of association was inversely related to age category, and PRs for a given age category were similar across disability types and severity levels. PRs for the association between any disability and hysterectomy were 2.18 (95% CI 1.36–3.50) for childbearing-aged women, 1.48 (95% CI 1.21–1.80) for perimenopausal women, and 1.12 (95% CI 1.02–1.24) for postmenopausal women. Conclusions: Prevalence of hysterectomy is disproportionately higher among women with self-reported disabilities compared with women without disabilities, with these differences most pronounced in women of childbearing age.
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Affiliation(s)
- Natalie V. Scime
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Hilary K. Brown
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Amy Metcalfe
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Erin A. Brennand
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, Alberta, Canada
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21
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Dumont S, Van Trappen P. The clinical and financial impact of introducing robotic-assisted hysterectomy in a tertiary referral centre: A direct cost analysis of consecutive hysterectomies during a decade. Int J Med Robot 2021; 18:e2343. [PMID: 34655461 DOI: 10.1002/rcs.2343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/16/2021] [Accepted: 10/15/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Economic data and the clinical impact of introducing robotic-assisted hysterectomy in a European setting are scarce with conflicting findings. METHODS In this retrospective cohort study, the cost and complication rate of the different approaches of hysterectomy are investigated, both benign and (pre)malignant indications were included. RESULTS 844 patients were included: 323 (38.3%) patients underwent robotic-assisted hysterectomy (RAH), 317 (37.5%) total abdominal hysterectomy (TAH), and 204 (24.2%) total laparoscopic hysterectomy (TLH). TAH dropped from 67.2% to 25.5% of procedures, whilst RAH rose to 41.8% of cases. The total hospitalisation cost was for RAH €5208.39 (±€916.91), for TAH €5846.61 (±€4464.37) and for TLH €3790.06 (±€1267.05). The postoperative complication rate of TAH (9.1%) was significantly higher in comparison with TLH and RAH (5.4% and 3.1%, respectively, p = 0.005). CONCLUSIONS RAH has replaced TAH in most cases, especially for large uteri, early-stage endometrial cancer and in selected endometriosis cases, resulting in reduced morbidity with lower hospitalisation costs. The indications for TLH remained, including menorrhagia, adenomyosis and persistent cervical dysplasia.
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Affiliation(s)
- Sander Dumont
- Department of Gynecology and Gynecological Oncology, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium.,Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Philippe Van Trappen
- Department of Gynecology and Gynecological Oncology, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
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22
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Giannella L, Marconi C, Di Giuseppe J, Delli Carpini G, Fichera M, Grelloni C, Giuliani L, Montanari M, Insinga S, Ciavattini A. Malignant Transformation of Postmenopausal Endometriosis: A Systematic Review of the Literature. Cancers (Basel) 2021; 13:4026. [PMID: 34439184 PMCID: PMC8394809 DOI: 10.3390/cancers13164026] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: This study aimed to systematically review the existing literature on malignant transformation of postmenopausal endometriosis to provide information about patient characteristics, hormonal replacement therapy (HRT) use, and outcomes over a period of 52 years (1969-2021). Methods: According to PRISMA guidelines, we searched for (endometriosis OR endometriotic) AND (cancer OR malignancy OR malignant transformation) AND (menopause OR menopausal OR postmenopause OR postmenopausal) in Pubmed (all fields) (accessed on 12 February 2021) and Scopus (Title/Abstract/Keywords) (accessed on 12 February 2021) databases. The only filter used was the English language. Relevant articles were obtained in full-text format and screened for additional references. Eligibility/inclusion criteria: studies including full case description of malignant transformation of endometriosis-related lesions in postmenopause. Results: 75 studies, including 90 cases, were retrieved. The mean age was 55.8 ± 8.5 years. Overall, about 65% of women had a positive personal history of endometriosis/adenomyosis, and 64% of women underwent previous hysterectomy ± bilateral salpingo-oophorectomy. Forty-nine of 74 women used HRT (66.2%). Among the women who used HRT, estrogen-only treatment was taken by approximately 75%. Duration of HRT was longer than five years in 63.3% of cases. About 70% of subjects had histology of endometrioid adenocarcinoma or clear cell carcinoma. Follow-up outcome, available for 61 women, showed a survival rate of 78.7%, recurrence of 9.8%, death of 11.5%. The duration of follow-up had a median of 12 months (interquartile range, 6.75-25 months). Interestingly, over the years of case publication there was a significant inverse correlation with previous history of endometriosis (r = -0.28, p = 0.007), HRT use (r = -0.31, p = 0.006), and previous definitive surgery (r = -0.42, p < 0.001). Conclusions: In the malignant transformation of postmenopausal endometriosis, there are some recurrent clinical conditions: previous endometriosis, major definitive surgery before menopause, and estrogen-only HRT for a relatively long time. However, these clinical conditions have shown a drastic decrease over time. This could likely be the consequence of different attitudes and management of gynecologists linked to up-to-date scientific evidence about the use of major surgery in gynecological pathologies. Malignant transformation of postmenopausal endometriosis is a clinical challenge to be explored further.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Andrea Ciavattini
- Woman’s Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Via Filippo Corridoni, 16, 60123 Ancona, Italy; (L.G.); (C.M.); (J.D.G.); (G.D.C.); (M.F.); (C.G.); (L.G.); (M.M.); (S.I.)
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23
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Kumar S, Vijan T. Hysterectomy: Rates and routes controversies. MGM JOURNAL OF MEDICAL SCIENCES 2021. [DOI: 10.4103/mgmj.mgmj_92_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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