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

P Persson, Jan Brynhildsen, Preben Kjølhede
In: BJOG: An International Journal of Obstetrics & Gynaecology · 2010 · vol. 117(4) , pp. 469–478 · doi:10.1111/j.1471-0528.2009.02468.x · PMID:20074264 · W1489343777
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This randomized trial found no difference in postoperative recovery between subtotal and total abdominal hysterectomy, with complications and preoperative psychological well-being strongly influencing recovery time.

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Abstract

OBJECTIVE: To determine whether the day-by-day postoperative recovery differs between women undergoing subtotal and total abdominal hysterectomy, and to analyse factors associated with postoperative recovery and sick leave. DESIGN: A prospective, open, randomised multicentre trial. SETTING: Seven hospitals and one private clinic in the south-east of Sweden. POPULATION: Two-hundred women scheduled for hysterectomy for benign conditions were enrolled in the study, and 178 women completed the study. Ninety-four women were randomised to subtotal abdominal hysterectomy; 84 women were randomised to total abdominal hysterectomy. METHODS: The day-by-day recovery of general wellbeing was measured on a visual analogue scale in a diary 7 days preoperatively and 35 days postoperatively. Psychometric measurements included depression, anxiety and general psychological wellbeing. MAIN OUTCOME MEASURES: Effects of operating method and preoperative wellbeing on the day-by-day recovery and duration of sick leave. RESULTS: No significant difference was found in the day-by-day recovery between operating methods. The day-by-day recovery of general wellbeing and duration of sick leave was strongly associated with the occurrence of minor complications, but not with major complications. The level of psychological wellbeing preoperatively was strongly associated with the day-by-day recovery of general wellbeing and duration of sick leave. CONCLUSIONS: Day-by-day recovery of general wellbeing is no faster in subtotal versus total abdominal hysterectomy. Independent of operation method there is an interaction between preoperative psychological wellbeing, postoperative recovery of general wellbeing and the duration of sick leave. Postoperative complications and preoperative psychological wellbeing are strong determinants for the duration of sick leave. There is a need for intervention studies with a focus on complications and preoperative wellbeing.
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