Effects of Shared Decision Making on Opioid Prescribing After Hysterectomy

OBJECTIVE

To evaluate the effects of shared decision making using a simple decision aid for opioid prescribing after hysterectomy.

METHODS

We conducted a prospective quality initiative study including all patients undergoing hysterectomy for benign, nonobstetric indications between March 1, 2018, and July 31, 2018, at our academic institution. Using a visual decision aid, patients received uniform education regarding postoperative pain management. They were then educated on the department's guidelines regarding the maximum number of tablets recommended per prescription and the mean number of opioid tablets used by a similar cohort of patients in a previously published study at our institution. Patients were then asked to choose their desired number of tablets to receive on discharge. Structured telephone interviews were conducted 14 days after surgery. The primary outcome was total opioids prescribed before compared with after implementation of the decision aid. Secondary outcomes included opioid consumption, patient satisfaction, and refill requests after intervention implementation.

RESULTS

Of 170 eligible patients, 159 (93.5%) used the decision aid (one patient who used the decision aid was subsequently excluded from the analysis owing to significant perioperative complications), including 110 (69.6%) laparoscopic, 40 (25.3%) vaginal, and eight (5.3%) abdominal hysterectomies. Telephone surveys were completed for 89.2% (n=141) of participants. Student's t-test showed that patients who participated in the decision aid (post-decision aid cohort) were discharged with significantly fewer oral morphine equivalents than patients who underwent hysterectomy before implementation of the decision aid (pre-decision aid cohort) (92±35 vs 160±81, P<.01), with no significant change in the number of requested refills (9.5% [n=15] vs 5.7% [n=14], P=.15). In the post-decision aid cohort, 76.6% of patients (n=121) chose fewer tablets than the guideline-allotted maximum. Approximately 76% of patients (n=102) reported having leftover tablets.

CONCLUSION

This quality improvement initiative illustrates that a simple decision aid can result in a significant decrease in opioid prescribing without compromising patient satisfaction or postoperative pain management.

Cost-effectiveness of an internet-based perioperative care programme to enhance postoperative recovery in gynaecological patients: economic evaluation alongside a stepped-wedge cluster-randomised trial

OBJECTIVES

To evaluate the cost-effectiveness and cost-utility of an internet-based perioperative care programme compared with usual care for gynaecological patients.

DESIGN

Economic evaluation from a societal perspective alongside a stepped-wedge cluster-randomised controlled trial with 12 months of follow-up.

SETTING

Secondary care, nine hospitals in the Netherlands, 2011-2014.

PARTICIPANTS

433 employed women aged 18-65 years scheduled for a hysterectomy and/or laparoscopic adnexal surgery.

INTERVENTION

The intervention comprised an internet-based care programme aimed at improving convalescence and preventing delayed return to work (RTW) following gynaecological surgery and was sequentially rolled out. Depending on the implementation phase of their hospital, patients were allocated to usual care (n=206) or to the intervention (n=227).

MAIN OUTCOME MEASURES

The primary outcome was duration until full sustainable RTW. Secondary outcomes were quality-adjusted life years (QALYs), health-related quality of life and recovery.

RESULTS

At 12 months, there were no statistically significant differences in total societal costs (€-647; 95% CI €-2116 to €753) and duration until RTW (-4.1; 95% CI -10.8 to 2.6) between groups. The incremental cost-effectiveness ratio (ICER) for RTW was 56; each day earlier RTW in the intervention group was associated with cost savings of €56 compared with usual care. The probability of the intervention being cost-effective was 0.79 at a willingness-to-pay (WTP) of €0 per day earlier RTW, which increased to 0.97 at a WTP of €76 per day earlier RTW. The difference in QALYs gained over 12 months between the groups was clinically irrelevant resulting in a low probability of cost-effectiveness for QALYs.

CONCLUSIONS

Considering that on average the costs of a day of sickness absence are €230, the care programme is considered cost-effective in comparison with usual care for duration until sustainable RTW after gynaecological surgery for benign disease. Future research should indicate whether widespread implementation of this care programme has the potential to reduce societal costs associated with gynaecological surgery.

TRIAL REGISTRATION NUMBER

NTR2933; Results.

Early postoperative bladder training in patients submitted to radical hysterectomy: is it still necessary? A randomized trial

OBJECTIVES

To evaluate the role of bladder training during postoperative hospital stay in patients submitted to nerve-sparing radical hysterectomy, and to identify any clinical or surgical factor associated with postoperative bladder dysfunction.

DESIGN, SETTING, AND PARTICIPANTS

Parallel group randomized single institution trial, on gynaecologic malignancies patients conducted in Catholic University of Sacred Heart Rome, between April 2009 and November 2011. Randomization was on 1:1, using a block randomized computer-generated list.

INTERVENTIONS

Patients underwent Querleu-Morrow type B2 or C1 radical hysterectomy. After 2 days from surgery, patients were randomized to perform or not bladder training (scheduled clamping and unclamping of the trans-urethral catheter every three hours). Main outcome measures Necessity and duration of clean intermittent self catheterization.

RESULTS

Randomized participants were 111 women (bladder training arm n = 55; control arm n = 56). A total of 22 women (19.8%) required clean intermittent self catheterization, equally distributed in the two arms. At univariate analysis, only the type of radical hysterectomy was significantly associated with need of clean intermittent self catheterization (type C1 vs. type B2; p = 0.013). At univariate analysis, duration of clean intermittent self-catheterization was not associated with age, BMI, type of hysterectomy and of neo-adjuvant treatment.

CONCLUSIONS

Functional bladder disfunctions are the most common long-term complications following radical hysterectomy. Systematic postoperative bladder training following nerve-sparing radical hysterectomy does not influence the rate of urinary retention or re-admission for bladder catheterization.

Effectiveness of a multidisciplinary care program on recovery and return to work of patients after gynaecological surgery; design of a randomized controlled trial

BACKGROUND

Return to work after gynaecological surgery takes much longer than expected, irrespective of the level of invasiveness. In order to empower patients in recovery and return to work, a multidisciplinary care program consisting of an e-health intervention and integrated care management including participatory workplace intervention was developed.

METHODS/DESIGN

We designed a randomized controlled trial to assess the effect of the multidisciplinary care program on full sustainable return to work in patients after gynaecological surgery, compared to usual clinical care. Two hundred twelve women (18-65 years old) undergoing hysterectomy and/or laparoscopic adnexal surgery on benign indication in one of the 7 participating (university) hospitals in the Netherlands are expected to take part in this study at baseline. The primary outcome measure is sick leave duration until full sustainable return to work and is measured by a monthly calendar of sickness absence during 26 weeks after surgery. Secondary outcome measures are the effect of the care program on general recovery, quality of life, pain intensity and complications, and are assessed using questionnaires at baseline, 2, 6, 12 and 26 weeks after surgery.

DISCUSSION

The discrepancy between expected physical recovery and actual return to work after gynaecological surgery contributes to the relevance of this study. There is strong evidence that long periods of sick leave can result in work disability, poorer general health and increased risk of mental health problems. We expect that this multidisciplinary care program will improve peri-operative care, contribute to a faster return to work of patients after gynaecological surgery and, as a consequence, will reduce societal costs considerably.

TRIAL REGISTRATION

Netherlands Trial Register (NTR): NTR2087.

[Analysis of need for sick leave after hysterectomy]

INTRODUCTION

The recommended sick leave after hysterectomy varies among operating wards and depends on many non-medical issues. The recommendation is rarely validated scientifically and is often without any connection to the women's actual handling of the leave if this is not recorded as part of a project. We analysed the postoperative period for a group of hysterectomised women who kept a diary over eight weeks.

MATERIALS AND METHODS

Between July 2005 and June 2006 all hysterectomised women entered the diary project if they fulfilled the following criteria: the operation was indicated by meno-metrorrhagia, dysplasia, pressure symptoms or pain, she was under 60, she was Danish-speaking and in full-time work which was to be recommenced after operation. Women were excluded if they were operated for descended uterus, if a major re-operation was performed or, unexpectedly, endometriosis or malignancy was found. Our ward's recommendation on sick leave was four weeks for vaginal hysterectomy and six weeks for abdominal hysterectomy, but with emphasis on the necessary individualization of sick leave. Once a week, the women answered eight questions on their well-being and activities in the diary and returned the diary.

RESULTS

In total, 71 women entered the study, 27 with vaginal hysterectomy and 44 with abdominal hysterectomy. After one week, none of the women suffered from nausea or discomfort, while 20% were still complaining of pain. Less than half of the women had commenced work one week after the recommended sick leave. At that time, two thirds had recommenced their former leisure activities but less than half of the women's sex lives were as before the operation.

CONCLUSION

The majority of women extend their sick leave beyond the recommended period on their own initiative, despite the ward's long recommended period of sick leave. It is questionable whether the actual period of sick leave can be cut by shortening the recommended sick leave.

Does postoperative misoprostol use induce intestinal motility? A prospective randomised double-blind trial

BACKGROUND

Misoprostol has been shown to increase colonic activity and decrease colonic transit time in chronic constipation patients.

AIMS

The aim of this prospective, randomised, double-blind study was to examine the effectiveness of rectally administered misoprostol on inducing intestinal motility after gynaecological surgery.

METHODS

Eighty women who underwent hysterectomy were divided randomly into three groups. Group A received misoprostol 200 microg rectally while group B received 400 microg rectal misoprostol after surgery before leaving the operating room. Patients in group C received no drugs. Bowel sounds in four quadrants were checked every hour and possible side-effects of misoprostol like nausea, vomiting, and distension were evaluated. The time interval between surgery and flatus pass and the need of analgesics were noted. Statistical analyses were done with Mann-Whitney U-test and chi2 tests where available.

RESULTS

The time between surgery and presence of bowel sounds in four quadrants were similar in all groups (2.7 +/- 1.6, 2.9 +/- 1.2, 2.8 +/- 1.3 h, for groups A, B, and C, respectively). No difference was observed in flatus pass time. The incidence of nausea was significantly increased in group B compared to controls (P < 0.01). Additional analgesic need was significantly higher in groups A and B when compared to controls (P < 0.05 and P < 0.01, for groups A and B, respectively).

CONCLUSION

Rectally administered misoprostol does not improve intestinal motility in the early postoperative period and thus, it is not effective in providing early oral food intake. On the contrary, it causes distention that requires additional analgesics and vomiting that naturally limits oral diet intake.

The effectiveness of hand acupuncture and moxibustion in decreasing pain and "coldness" in Korea women who have had hysterectomy: a pilot study

This pilot study compared the relative effectiveness of hand acupuncture and moxibustion in relieving pain and decreasing "coldness" in certain body parts experienced by subjects who have undergone a hysterectomy. The study participants were 10 women between 40 and 65 years, whose hysterectomies had been performed within 5 years before the study. The 10 subjects were divided randomly into two independent experimental groups, with one group being treated with hand moxibustion, whereas the other group received hand acupuncture therapy. The visual analogue scale evaluation tool was used to measure the pain and digital infrared thermographic imaging to measure "coldness" and blood circulation. When measuring the degree of pain, it was noted that pain scores decreased conspicuously over time. The responses of the two groups did not differ significantly, but moxibustion therapy was found to increase the temperature of internal parts of the body (i.e., abdominal and waist areas), whereas acupuncture affected the peripheral parts of the body.

No difference in length of hospital stay between laparoscopic and abdominal supravaginal hysterectomy – a preliminary study

BACKGROUND

Although a number of well-designed studies have concluded that laparoscopic hysterectomy is associated with less postoperative pain, reduced hospital stay, and shorter periods of sick leave, thus far, studies on the perioperative and postoperative outcomes of laparoscopic supravaginal hysterectomy (LSH) versus abdominal supravaginal hysterectomy (ASH) are lacking. By applying multimodal intervention program for the postoperative care of patients, the primary aim of the current study was to compare length of hospital stay, time to convalescence, and long-term patient satisfaction between LSH and ASH.

METHOD

The study was conducted at the departments of Obstetrics and Gynecology, Skellefteå Hospital and Lycksele Hospital. Forty-seven consecutive women scheduled for supravaginal hysterectomy were randomly assigned to LSH or ASH. Perioperative and postoperative parameters were compared between the two groups.

RESULTS

The length of the postoperative hospital stay did not differ between patients undergoing LSH and ASH, but the number of disability days was greater in the ASH group. The operating time was significantly longer in the LSH group compared with the ASH group, whereas the estimated perioperative bleeding was greater in the ASH group. At the 6-month follow-up, 87.0% of patients in the ASH group and 91.3% in the LSH group were satisfied or very satisfied with the overall result of the surgical procedure.

CONCLUSION

The present study has indicated that by applying a multimodal intervention program for the postoperative care of patients undergoing supravaginal hysterectomy, the surgical procedure per se is of less importance than generally considered for the length of postoperative hospital stay and long-term patient satisfaction.

Hysterectomy: effects on quality of life and psychological aspects

Most gynaecological disorders are not life-threatening. They may nevertheless severely affect women's quality of life. The majority of hysterectomies are performed to treat non-malignant conditions, to enhance the quality of life rather than save life. Recent research shows an enhancement in quality of life during the early years after hysterectomy. Furthermore, research shows that hysterectomy does not cause any adverse psychological outcome in otherwise psychologically healthy women, but presurgical psychopathology is predictive of postsurgical psychopathology. Research also shows that most gynaecological cancer survivors enjoy a relatively good quality of life.

Preoperative teaching and hysterectomy outcomes

This study used a theoretical model to determine whether an efficacy-enhancing teaching protocol was effective in improving immediate postoperative behaviors and selected short- and long-term health outcomes in women who underwent abdominal hysterectomies. The model used was the self-efficacy theory of Albert Bandura, PhD. One hundred eight patients in a 486-bed teaching hospital in the Midwest who underwent hysterectomies participated. The participation rate was 85%, and the attrition rate was 17% during the six-month study. The major finding was that participants in the efficacy-enhancing teaching group ambulated significantly longer than participants in the usual care group. This is an important finding because the most prevalent postoperative complications after hysterectomy are atelectasis, pneumonia, paralytic ileus, and deep vein thrombosis, and postoperative ambulation has been shown to decrease or prevent all of these complications. This finding could affect the overall health status of women undergoing hysterectomies.

Fast track hysterectomy

OBJECTIVE

To identify factors limiting early discharge after laparoscopically assisted vaginal hysterectomy (LAVH) and abdominal hysterectomy, in a fast track setting with emphasis on information, treatment of pain, early mobilization, and early food intake.

STUDY DESIGN

A prospective, descriptive study of 32 unselected women allocated to either abdominal hysterectomy (n=16) or LAVH (n=16). The patients received the same information, care, and advice for the perioperative period except for an assumed 1-day hospital stay in the LAVH-group and 2 days in the abdominal group.

RESULTS

Patients were discharged median 1 day (1-3) after LAVH and 2 days (2-4) after abdominal hysterectomy. Work was resumed median 23 days after abdominal hysterectomy and 28 days after LAVH (P > 0.05).

CONCLUSIONS

The study questions the previously proposed advantages of shortened hospitalization and convalescence after LAVH compared with abdominal hysterectomy. Further studies with active rehabilitation are needed to demonstrate real differences between laparoscopic and open hysterectomy.

[Integrated gynecology: new medical treatments due to psychosomatic methods of evaluation]

OBJECTIVE

Women with gynecologic cancer are confronted with difficult decisions regarding the therapeutic options. The objective of the present paper is to demonstrate the relationship between surgical procedures and the outcome on quality of life and to discuss the implications for patient management.

METHODS

Gynecologic patients were assessed in a prospective study with preoperative semistructured interviews and objective assessments (T1), interviews were repeated 4 and 12 months postoperatively (T2, T3).

RESULTS

Women planned for hysterectomy with severe complaints indicate a better postoperative quality of life. Cancer patients, however, tend to feel more distressed about the surgical procedure if they could not be treated organ preserving or by reconstructive techniques. Medical interaction is dependent on the patient's anxiety level and mostly important for their quality of life before and after surgery.

CONCLUSION

Psychosomatic research is not only necessary to understand the patient's needs before and after surgery but may also serve as an evaluation method of therapeutical options. By this methods we are able to anticipate the medical and psychological consequences of the therapeutic decisions. Future studies will systematically explore the alternating effect of surgical procedures on the patient's well-being.

Behavioural treatment (biofeedback) for constipation following hysterectomy

BACKGROUND

Constipation after hysterectomy has been postulated to be due to pelvic nerve damage, but there may be emotional or reversible physical factors of pathophysiological relevance. The aim of this study was to determine whether such constipation is responsive to behavioural treatment.

METHODS

Three groups of patients who had completed a course of biofeedback treatment were compared: women with no history of abdominal or pelvic surgery (n = 25), women for whom a hysterectomy had led to no change in bowel function (n = 27) and women who stated that their constipation was precipitated (n = 18) or severely worsened (n = 8) by hysterectomy. Pretreatment and post-treatment details about bowel function and symptoms were assessed using structured interview, and pretreatment whole-gut transit time and anorectal physiology testing were assessed for prognostic relevance.

RESULTS

Follow-up after completing treatment was a median of 28 (range 12-44) months. Forty-eight of 78 patients considered that their constipation had improved with treatment; the proportion in each group was similar (P = 0.73). Biofeedback reduced the need to strain, reduced abdominal pain, improved bowel frequency, and reduced laxative use to a similar degree in all three groups. Thirty-three of 53 patients with slow transit considered there was an improvement, compared with 15 of 22 with measured normal transit. Physiological testing did not predict outcome and did not differ between the three groups.

CONCLUSION

The majority of patients complaining of constipation induced or worsened by hysterectomy respond subjectively to behavioural treatment, in a similar proportion to those with idiopathic constipation. In contrast to the widely held view that nerve damage is responsible for symptoms, reversible factors are likely to be important in many patients.

[Anxiety and coping behavior before and after radical gynecological surgery]

Pretreatment phase-interactions between patient, family and medical staff around the time of diagnosis may have profound and long-term effects on quality of life. These interactions do not only influence the ability of the patient to come to terms with the diagnosis, but often set the tone for all future dealings with medical community. The imperatives for the medical staff in this process are to provide both: information and hope. In this context, anxiety and defense mechanisms--as protection of ego against anxiety--are psychoanalytic based constructs. The investigation of the interference between these constructs and information reflects the extraordinary background for an effective and continuing communication. These considerations require the care team to individualize their approach to each patient.

Maximising the use of HRT: focus on hysterectomised women

Hysterectomy is one of the most common gynaecological surgical operations performed in the UK. In addition to causing the early onset of the menopause, hysterectomy can lead some women to be at increased risk of future CHD and osteoporosis owing to declining oestrogen levels. Hysterectomised women are therefore an ideal group to receive hormone replacement therapy (HRT). However, only small numbers of women receive HRT owing to a number of factors, including fear of potential complications and adverse side-effects. Of those women who do receive HRT, compliance with therapy is low. In this article, the authors weigh the benefits of HRT, in terms of relief of menopausal symptoms, and prevention of osteoporosis, Alzheimer's disease and cardiovascular disease, against the known risks. The authors suggest that compliance with HRT could be optimised by profiling patients in general practice and by educating women on the long-term benefits of HRT.

Sexual activity questionnaires in clinical trials: acceptability to patients with gynaecological disorders

OBJECTIVE

To assess the feasibility and acceptability of including sexual activity questionnaires in gynaecological clinical trials.

DESIGN

A longitudinal quality of life study during the Maintenance Interferon Trial and the EVALUATE Hysterectomy Trial.

SETTING

Gynaecology clinics and women's homes.

SAMPLE

Ninety-six women with advanced ovarian cancer participating in the Maintenance Interferon Trial and 542 women undergoing a hysterectomy in the EVALUATE Hysterectomy Trial.

METHODS

Quality of life questionnaires, including the sexual activity questionnaire, were completed by women prior to randomisation and periodically after randomisation.

MAIN OUTCOME MEASURES

Compliance rates of the sexual activity questionnaire, both overall and with respect to the level of sexual functioning and age of the women. Attitudes of the women towards completing the questionnaire, and suitability of using the sexual activity questionnaire in clinical trials.

RESULTS

Compliance rates of over 80% were achieved in both trials, both overall and for each questionnaire completed. The age of the woman did not appear to influence the completion of the questionnaire, nor did her level of sexual functioning. Women were supportive of the research and did not find the questionnaire intrusive.

CONCLUSIONS

It is feasible to include sexual activity questionnaires in gynaecological clinical trials requiring repeated assessment of quality of life over a long period of time. The sexual activity questionnaire is an appropriate tool to carry out investigations of sexual functioning and is worth considering for use in future clinical trials.

Randomised controlled trial comparing hospital at home care with inpatient hospital care. I: three month follow up of health outcomes

OBJECTIVES

To compare hospital at home care with inpatient hospital care in terms of patient outcomes.

DESIGN

Randomised controlled trial with three month follow up.

SETTING

District general hospital and catchment area of neighbouring community trust.

SUBJECTS

Patients recovering from hip replacement (n=86), knee replacement (n=86), and hysterectomy (n=238); elderly medical patients (n=96); and patients with chronic obstructive airways disease (n=32).

INTERVENTIONS

Hospital at home care or inpatient hospital care.

MAIN OUTCOME MEASURES

Dartmouth COOP chart to measure patients' general health status; SF-36 to measure possible limitations in physical functioning of patients with hysterectomy; disease specific measures-chronic respiratory disease questionnaire, Barthel index for elderly medical patients, Oxford hip score, and Bristol knee score; hospital readmission and mortality data; carer strain index to measure burden on carers; patients' and carers' preferred form of care.

RESULTS

At follow up, there were no major differences in outcome between hospital at home care and hospital care for any of the patient groups except that those recovering from hip replacement reported a significantly greater improvement in quality of life with hospital at home care (difference in change from baseline value 0.50, 95% confidence interval 0.13 to 0.88). Hospital at home did not seem suitable for patients recovering from a knee replacement, as 14 (30%) of patients allocated to hospital at home remained in hospital. Patients in all groups preferred hospital at home care except those with chronic obstructive airways disease. No differences were detected for carer burden. Carers of patients recovering from knee replacement preferred hospital at home care, while carers of patients recovering from a hysterectomy preferred hospital care.

CONCLUSIONS

Few differences in outcome were detected. Thus, the cost of hospital at home compared with hospital care becomes a primary concern.

Does a shorter length of hospital stay affect the outcome and costs of hysterectomy in southern England?

STUDY OBJECTIVE

To see whether a shorter postoperative length of stay (LOS) for a major procedure, abdominal hysterectomy for benign conditions, was associated with health outcome, the use of formal and lay care after discharge, cost, and satisfaction.

DESIGN

Prospective cohort study.

SETTING

Three hospitals in London and three in Hertfordshire and Bedfordshire.

PATIENTS

A total of 363 women undergoing total abdominal hysterectomy with or without oophorectomy: 112 with a short postoperative LOS (five days or less) and 251 with a standard LOS (six days or more).

MAIN OUTCOME MEASURES

Wound infection within 10 days and six weeks; change in general health status (Nottingham health profile) after six weeks; general health and change in social activity (lifestyle index) three months after surgery. Mean cost difference for hospitals, use of formal and lay care after discharge, and patient satisfaction.

RESULTS

Short LOS was associated with benefits: a lower risk of wound infection in the first 10 days (odds ratio 0.44; p = 0.03) and no deterioration in physical mobility (measured using the NHP) after six weeks- and with adverse outcomes: constipation six weeks later (OR 0.48; p < 0.001) and moderate or severe urinary symptoms six weeks (OR 0.69; p < 0.004) and three months (OR 0.65; p < 0.008) later. On multivariate analysis, the only outcome to remain significantly associated with LOS was physical mobility after six weeks (p = 0.024). There was no significant difference between short and standard stay women as regards their use of formal or lay care after discharge from hospital. The mean cost of hospital care was Pounds251 (in 1992) less for short than for standard stay patients. Most women (73% at six weeks) felt their LOS was appropriate. Short stay women were more likely to feel it was too short, though the difference was not statistically significant.

CONCLUSIONS

Short postoperative stays do not seem to be associated with any adverse outcomes and result in modest financial saving to the health service. There is potential for greater use of early discharge.

A comparison of recovery following hysterectomy and major cardiac surgery

Although monitoring progress is an everyday nursing activity, methods currently employed remain relatively undeveloped. In the past most studies documented physical recovery, tending to focus upon complications such as infection rates, which are quantifiable. Patients' satisfaction with progress is seldom taken into account, although it may provide a more accurate reflection of progress. In this paper, recovery following major cardiac surgery and hysterectomy performed for benign lesions are compared in terms of psychological adjustment to the effects of surgery and resumption of a wide range of activities within and outside the home, in addition to physical progress. On the whole patients accepted the effects of hysterectomy and their own assessments of recovery proved favourable despite considerable residual physical problems of a minor but troublesome nature. In contrast, recovery from cardiac surgery was more difficult and proceeded more slowly, as expected following this major operation.

[Ability to work following radical surgery for cervix carcinoma]

During follow-up examinations of 74 women after radical hysterectomy the time interval between the end of treatment and the start of the subsequent professional activity has been examined. 34.1% of the patients started to work after 3 months, 46.8% worked within 6 months, 72.3% within 12, and 87.2% within 18 months. 61.7% of the women worked in the same job as before their operation, 29.8% started in an new job. The results are in full agreement with the personal opinion of 73.1% of all women who consider a space of up to 6-7 months optimal for their rehabilitation, up to 3 months was ideal for not less than 44.7%. A sick leave of up to 6 months was considered essential and helpful by 51% of all women. In 74.5% of all cases the date for the start in their professional work was in agreement with the personal plan of the women. It is concluded from these results that 3 months after treatment the problem of professional work should be discussed with the patient, provided that she is free of recurrence. This time interval is optimal from the patient's standpoint.