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. 2013 Oct 28;3(10):e003169.
doi: 10.1136/bmjopen-2013-003169.

Ten years of progress--improved hysterectomy outcomes in Finland 1996-2006: a longitudinal observation study

Juha Mäkinen  1 , Tea Brummer, Jyrki Jalkanen, Anna-Mari Heikkinen, Jaana Fraser, Eija Tomás, Päivi Härkki, Jari Sjöberg
Affiliations

Ten years of progress--improved hysterectomy outcomes in Finland 1996-2006: a longitudinal observation study

Juha Mäkinen et al. BMJ Open. .

Abstract

Objectives: To study the outcome of various hysterectomies in 2 years 1996 (N =10110) and 2006 (N=5279). The hypothesis was that the change in operative practices in 10 years has resulted in improvements.

Design: 2 prospective nationwide cohort evaluations with the same questionnaire.

Setting: All national operative hospitals in Finland.

Participants: Patients scheduled to either abdominal hysterectomy (AH), vaginal hysterectomy (VH) or laparoscopic hysterectomy (LH) for benign disease.

Outcome measures: Patients' characteristics, surgery-related details and complications (organ injury, infection, venous thromboembolism and haemorrhage).

Results: The overall complication rates fell in LH and markedly in VH (from 22.2% to 11.7%, p<0.001). The overall surgery-related infectious morbidity decreased in all groups and significantly in VH (from 12.3% to 5.2%, p<0.001) and AH (from 9.9% to 7.7%, p<0.05). The incidence of bowel lesions in VH sank from 0.5% to 0.1% and of ureter lesions in LH from 1.1% to 0.3%. In 2006 there were no deaths compared with three in 1996.

Conclusions: The rate of postoperative complications fell markedly in the decade from 1996 to 2006. This parallels with the recommendation of the recent meta-analyses by Cochrane collaboration; the order of preference of hysterectomies was for the first time precisely followed in this nationwide study.

Trial registration: The 2006 study was registered in the Clinical Trials of Protocol Registration System Data (NCT00744172).

Keywords: Gynaecology.

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Figures

Figure 1
Figure 1
Proportions of abdominal, vaginal and laparoscopic hysterectomies in various countries from 1994 to 2006. Figures from France represent samples from University clinics only, otherwise national data are presented, apart from the UK, which excludes Wales, and represents 45% of national hysterectomies. References: UK 1994–1995, 7 Finland 1996, 8 France 1996, 9 Taiwan 1996,5 USA 1997,10 Denmark 1998-2000, 11 Norway 2000-2001, 12 USA 2000,2004, 13 Netherlands 2002,14 France 2004, 9 Sweden 2004,15 Denmark 2004, 4 Australia 2005-2005, 16 Taiwan 2005,5 Germany,17 Denmark 2006, 4 and Finland 2006.6
Figure 2
Figure 2
Proportion of hysterectomies by type in Finland in 1996 and 2006. AH, abdominal hysterectomy; VH, vaginal hysterectomy; LH, laparoscopic hysterectomy.
Figure 3
Figure 3
Complications related to abdominal, vaginal and laparoscopic hysterectomies in 1996 and 2006. VTE, venous tromboembolism. *Pelvic infection data from 1996 comprise all intra-abdominal and vaginal infections, whereas in 2006 was late onset of pelvic infection was defined as pelvic abscess or hematoma. **N of patients. A patient may have had more than one complication (*) including vaginal cuff infection.
See this image and copyright information in PMC

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