Ewa Jokinen1, Tea Brummer2, Jyrki Jalkanen3, Jaana Fraser4, Anna-Mari Heikkinen5, Juha Mäkinen6, Jari Sjöberg7, Eija Tomàs8, Tomi S Mikkola7, Päivi Härkki7. 1. Department of Obstetrics and Gynecology, Hospital District of Helsinki and Uusimaa/Hyvinkää Hospital, Hyvinkää, Finland. 2. Department of Obstetrics and Gynecology, Østfold Central Hospital, Fredrikstad, Norway. 3. Department of Obstetrics and Gynecology, Central Finland Central Hospital, Jyväskylä, Finland. 4. Department of Obstetrics and Gynecology, North Karelia Central Hospital, Joensuu, Finland. 5. Terveystalo Private Healthcare Service, Kuopio, Finland. 6. Department of Obstetrics and Gynecology, Turku University Hospital, Turku, Finland. 7. Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland. 8. Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland.
Abstract
OBJECTIVE: To assess trends for hysterectomy methods in the Nordic countries and to compare outcomes of hysterectomies in Finland done by trainees with those done by specialists. DESIGN: Register-based study. SETTING: NOMESCO database for the Nordic countries and the Finnish Hospital Discharge Register. POPULATION: National prospective cohort of 5279 hysterectomies in Finland. METHODS: Numbers of hysterectomies in the Nordic countries were collected in 1995-2011 and in Finland in 1990-2012. The Finhyst study to collect data on hysterectomies for benign indications was carried out in Finland in 2006. Information concerning patients, surgeons, and hysterectomy outcome was analysed. MAIN OUTCOME MEASURES: Hysterectomy numbers and methods. Operating time, blood loss, and complications in hysterectomies done by trainees and specialists. RESULTS: In Finland, the rate of hysterectomies has been reduced by approximately 50% since the 1990s and is now similar to that in the other Nordic countries. The laparoscopic method is twice as common in Finland as in other Nordic countries, constituting 35-40% of all hysterectomies. The operating time for all hysterectomy methods was 16-25% longer among trainees than specialists. For the abdominal or laparoscopic methods there were no significant differences in the complication rates between the groups. In the vaginal approach, blood loss of ≥1000 mL was slightly more common in operations done by trainees (1.3% vs. 2.6%, p = 0.037). CONCLUSIONS: Laparoscopic hysterectomy is more common in Finland than in the other Nordic countries. Although trainees need more time to operate, there were no differences between the trainees and the specialists with regard to major complication rates.
OBJECTIVE: To assess trends for hysterectomy methods in the Nordic countries and to compare outcomes of hysterectomies in Finland done by trainees with those done by specialists. DESIGN: Register-based study. SETTING: NOMESCO database for the Nordic countries and the Finnish Hospital Discharge Register. POPULATION: National prospective cohort of 5279 hysterectomies in Finland. METHODS: Numbers of hysterectomies in the Nordic countries were collected in 1995-2011 and in Finland in 1990-2012. The Finhyst study to collect data on hysterectomies for benign indications was carried out in Finland in 2006. Information concerning patients, surgeons, and hysterectomy outcome was analysed. MAIN OUTCOME MEASURES: Hysterectomy numbers and methods. Operating time, blood loss, and complications in hysterectomies done by trainees and specialists. RESULTS: In Finland, the rate of hysterectomies has been reduced by approximately 50% since the 1990s and is now similar to that in the other Nordic countries. The laparoscopic method is twice as common in Finland as in other Nordic countries, constituting 35-40% of all hysterectomies. The operating time for all hysterectomy methods was 16-25% longer among trainees than specialists. For the abdominal or laparoscopic methods there were no significant differences in the complication rates between the groups. In the vaginal approach, blood loss of ≥1000 mL was slightly more common in operations done by trainees (1.3% vs. 2.6%, p = 0.037). CONCLUSIONS: Laparoscopic hysterectomy is more common in Finland than in the other Nordic countries. Although trainees need more time to operate, there were no differences between the trainees and the specialists with regard to major complication rates.
Authors: Britton Trabert; Rebecca Troisi; Tom Grotmol; Anders Ekbom; Anders Engeland; Mika Gissler; Ingrid Glimelius; Laura Madanat-Harjuoja; Henrik Toft Sørensen; Steinar Tretli; Anne Gulbech Ording; Tone Bjørge Journal: Int J Cancer Date: 2019-06-20 Impact factor: 7.316
Authors: Andreas Obermair; Nigel R Armfield; Nicholas Graves; Val Gebski; George B Hanna; Mark G Coleman; Anne Hughes; Monika Janda Journal: BMJ Open Date: 2019-05-09 Impact factor: 2.692