INDICATIONS FOR AND OUTCOME OF TOTAL ABDOMINAL HYSTERECTOMY FOR BENIGN DISEASE - A PROSPECTIVE COHORT STUDY

Objective To describe the indications for total abdominal hysterectomy for women with nonmalignant disease and to determine the immediate (i nitial ten days) and medium term outcome. Design A prospective cohort study. Setting Three district general hospitals in shire counties, two in outer London and one London teaching hospital. Subjects Three hund red and sixty-six women undergoing total abdominal hysterectomy (with or without other procedures) for nonmalignant disease. Interventions S elf-completed patient questionnaires before and ten days, six weeks an d three months after surgery. Data extracted from patients' hospital c ase notes. Main outcome measures Complications plus change in symptoms , urinary and bowel function, general health status, sexual function, activities of daily living and quality of life. Results The principal indications were bleeding, pain or both. Symptoms were severe enough t o be socially debilitating and have a major impact on lifestyle. Other wise, the women were in good health. During the first ten post-operati ve days the women suffered more pain, urinary discomfort, constipation and a reduction in their ability to perform activities of daily livin g. Urinary (25%) and wound (25%) infections were the commonest complic ations. At the same time, significant improvements in psychological he alth occurred. By six weeks, the principal symptoms had resolved for 9 5% of the women and early adverse effects on urinary and bowel functio n had settled. This was reflected in improvements in health status and quality of life including sexual activity. Despite this, these change s did not meet the pre-operative expectations of some women. Conclusio ns Most women reported substantial benefits from hysterectomy. However , women should be warned about early, transient adverse effects. These findings can serve as a benchmark for nonexperimental evaluations of the effectiveness of new treatment modalities.