Short-Term Recovery After Subtotal and Total Abdominal Hysterectomy—A Randomized Clinical Trial

Abstract

Although it is commonly believed that recovery from subtotal abdominal hysterectomy (SH) is associated with fewer complications and less pelvic organ dysfunction than total abdominal hysterectomy (TH), there is little data supporting this belief in the literature. Previous studies have found no difference in the postoperative recovery time between these procedures. Overall recovery after hysterectomy depends on treatment of postoperative physical symptoms and complications. Some studies have shown that recovery also depends on preoperative psychological well being and postoperative overall well being. The impact of these factors on the postoperative day-by-day recovery has not been investigated. This prospective randomized, controlled, open, multicenter study assessed possible differences between SH and TH in the day-by-day postoperative recovery, and also analyzed factors associated with postoperative recovery and sick leave. The study was conducted at 7 hospitals and 1 private gynecological clinic in Sweden between 1998 and 2004. The study subjects were 200 women who were scheduled for hysterectomy because of benign gynecological conditions. Of the 178 patients who completed the study, 94 were randomized to a SH group and 84 to a TH group. Assessment of day-by-day recovery of general well being was made using a patient diary with daily entries initiated at 1 week before surgery and continuing until the 35th postoperative day; the results were calculated on a visual analogue scale. Psychometric measurements included depression and anxiety; general psychological well being was also assessed. The primary study outcome measures were the associations between day-by-day recovery of general well being and duration of sick leave with mode of hysterectomy. The data showed no significant difference in the SH and TH groups for the day-by-day recovery of general well being in the preoperative and postoperative periods. A strong association was found between both postoperative day-by-day recovery of general well being and the duration of sick leave, with the occurrence of minor complications, but there was no significant association for major complications. The postoperative day-by-day recovery of general well being and duration of sick leave were strongly associated with the level of preoperative psychological well being. These findings show no difference in the speed of day-by-day recovery of general well being between the 2 procedures, but demonstrate an association between postoperative recovery of general well being and the duration of sick leave with preoperative psychological well being. Strong determinants for a prolonged sick leave include minor postoperative complications and a low preoperative level of psychological well being.