Health‐related quality of life and postoperative recovery in fast‐track hysterectomy

Abstract

Objective: To determine whether health-related quality of life (HRQoL) and postoperative recovery of women who undergo abdominal hysterectomy in a fast track program under general anesthesia (GA) differ from women who receive spinal anesthesia with intrathecal morphine (SA).Design: Secondary analysis from an open randomized controlled multicentre study.Setting: Five hospitals in south east Sweden.Population: 180 women admitted for abdominal hysterectomy for benign disease were randomized; 162 completed the study, 80 to GA and 82 to SA.Methods: HRQoL was measured pre-operatively using the EuroQoL EQ-5D and the ShortForm-36 health survey (SF-36) questionnaires. EQ-5D was used daily for one week; thereafter once weekly for four weeks and again six months after operation. SF-36 was completed at five weeks and six months. Dates of commencing and ending sick leave were registered. Main outcome measures:Changes in HRQoL; duration of sick leave.Results: HRQoL improved significantly faster in women after SA than after GA. Sick leave was significantly shorter after SA than after GA (median 22.5 vs. 28 days). Recovery of HRQoL and duration of sick leave were negatively influenced by postoperative complications.In particular, the mental component of HRQoL was negatively affected by minor complications, even six months after the operation. Conclusions:Spinal anesthesia with intrathecal morphine provided substantial advantages in fast track abdominal hysterectomy for benign gynecological disorders by providing faster recovery and shorter sick leave compared with general anesthesia. Fast track hysterectomy and quality of life3

Increased postoperative day one discharges after implementation of a hysterectomy enhanced recovery pathway: a retrospective cohort study

“…Implementation of an enhanced recovery pathway at our institution readied patients for a discharge on POD 1, which is earlier than other studies of gynecological patients. [16][17][18][19] Studies of enhanced recovery in gynecology have focused on laparoscopic surgery or featured a mix of benign and malignant surgical indications. 15,16 We describe a pathway oriented specifically at an open surgical approach for treating benign disease that allows practitioners to identify patients appropriate for HER pathway application.…”

“…17 To guide the development of our pathway, we performed a structured review of the literature using PubMed, Google Scholar, and Embase databases to identify evidence-based interventions associated with improved pain control and functional recovery, decreased nausea and vomiting, or decreased LOS after gynecologic surgery. Our review revealed that: 1) spinal anesthesia, in comparison with general anesthesia, is associated with shorter sick leaves 18 and improved quality of recovery and of life scores; 19 2) compared with general anesthesia, spinal anesthesia with intrathecal morphine reduces postoperative pain, ileus, fatigue, hospital LOS, and nausea and vomiting for up to 24 hr postoperatively; 20,21 3) transversus abdominis plane (TAP) blocks are associated with improved postoperative pain control and reduced rates of nausea and vomiting; 22 4) foundational multi-modal analgesia achieves postoperative pain control effectively and efficiently. 23,24 Hysterectomy enhanced recovery pathway Review of the literature, in combination with clinical expertise of the multi-disciplinary team was used to create the hysterectomy enhanced recovery (HER) pathway.…”

Innovations in the Care of Postoperative Hysterectomy Patients

“…Side effects of spinal anaesthetic were, however also clearly demonstrated with increases in vomiting and pruritis after spinal anaesthetic. (Wodlin, 2011b(Wodlin, , 2011c(Wodlin, , 2011d The second trial looking at mode of anaesthesia, by Kroon et al (2010), compared different anaesthetic methods (PCA and volatile anaesthesia vs. intrathecally administered morphine and TIVA) in 53 randomised patients undergoing abdominal hysterectomy for benign indications. It was noted that most of the uteri in the study were oversized as normal practice in the unit in question was to opt for vaginal hysterectomy for normal-sized uteri.…”

“…(Wodlin, 2011a, 2011b, 2011c, Kroon, 2010 The work by the 'GASPI' study group was a multicentre randomised controlled trial involving a total of 162 women undergoing total or subtotal hysterectomy for benign indications. The patients were relatively fit: contraindications to participation in the trial included an ASA score of ≥3, gynaecological malignancy and physical or psychiatric disability.…”

“…A later paper in the same journal issue entitled 'Health-related quality of life and postoperative recovery in fast-track hysterectomy' (Wodlin, 2011c) reported differences in health-related quality of life and duration of sick leave between the two study groups in the 'GASPI' study. Faster postoperative improvements in health-related quality of life and shorter sick leave were seen after surgery under spinal anaesthetic than with general anaesthetic although it was noted that these outcomes were influenced by complications in both groups.…”