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Attitudes to mode of hysterectomy--a survey-based study among Swedish gynecologists
Pär Persson1, Thomas Hellborg, Jan Brynhildsen
1Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynecology, Faculty of Health Sciences, University Hospital, 581 85 Linköping, Sweden. par.persson@akademiska.se
Objective:
To determine gynecologists' attitudes to mode of hysterectomy on benign indication.
Design:
Cross-sectional study.
Setting:
Sweden.
Population:
Members of the Swedish Society of Obstetrics and Gynecology.
Methods:
A postal questionnaire. Questions examined attitudes to mode of hysterectomy based on three clinical scenarios with different conditions of the uterus. Gynecologists were also asked to estimate how the distribution of the different modes of benign hysterectomy should be overall. The modes to choose were total abdominal, subtotal abdominal, laparoscopic or vaginal hysterectomy (VH). Analyses were performed with multiple logistic regression and multivariate analysis of covariance.
Main Outcome Measures:
Preferred mode of hysterectomy in the three scenarios and distribution of modes of hysterectomy.
Results:
VH was the most preferred method in general as well as when the uterus was of normal size, whereas subtotal and total abdominal hysterectomy were the most favored methods when the uterus was enlarged. VH was more often preferred by male compared to female gynecologists as a personal preference. The choice and distribution of mode varied significantly between place of work, seniority and in the quantity of yearly performed hysterectomies. The minimal invasive methods, vaginal and laparoscopic hysterectomy, were recommended in more than 50% of the overall suggested distribution.
Conclusion:
Personal choice of mode of hysterectomy does not seem to strictly follow evidence-based recommendations, but varies significantly between gynecologist's gender, type of clinical setting in which the gynecologist works, seniority and by how many hysterectomies the gynecologist does annually.
