ResearchPad - abdominal-hysterectomy https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Regional variation of hysterectomy for benign uterine diseases in Switzerland]]> https://www.researchpad.co/article/elastic_article_14622 Hysterectomy is the last treatment option for benign uterine diseases, and vaginal hysterectomy is preferred over more invasive techniques. We assessed the regional variation in hysterectomy rates for benign uterine diseases across Switzerland and explored potential determinants of variation.MethodsWe conducted a population-based analysis using patient discharge data from all Swiss hospitals between 2013 and 2016. Hospital service areas (HSAs) for hysterectomies were derived by analyzing patient flows. We calculated age-standardized mean procedure rates and measures of regional variation (extremal quotient [EQ], highest divided by lowest rate) and systematic component of variation [SCV]). We estimated the reduction in the variance of crude hysterectomy rates across HSAs in multilevel regression models, with incremental adjustment for procedure year, age, cultural/socioeconomic factors, burden of disease, and density of gynecologists.ResultsOverall, 40,211 hysterectomies from 54 HSAs were analyzed. The mean age-standardized hysterectomy rate was 298/100,000 women (range 186–456). While the variation in overall procedure rate was moderate (EQ 2.5, SCV 3.7), we found a very high procedure-specific variation (EQ vaginal 5.0, laparoscopic 6.3, abdominal 8.0; SCV vaginal 17.5, laparoscopic 11.2, abdominal 16.9). Adjusted for procedure year, demographic, cultural, and sociodemographic factors, a large share (64%) of the variance remained unexplained (vaginal 63%, laparoscopic 85%, abdominal 70%). The main determinants of variation were socioeconomic/cultural factors. Burden of disease and the density of gynecologists was not associated with procedure rates.ConclusionsSwitzerland has a very high regional variation in vaginal, laparoscopic, and abdominal hysterectomy for benign uterine disease. After adjustment for potential determinants of variation including demographic factors, socioeconomic and cultural factors, burden of disease, and the density of gynecologists, two thirds of the variation remain unexplained. ]]> <![CDATA[Maternal outcome after abdominal packing for uncontrolled postpartum hemorrhage despite peripartum hysterectomy]]> https://www.researchpad.co/article/5989db5cab0ee8fa60be01e6

Background

Intra-abdominal packing is a possible option for persistent bleeding following hysterectomy for postpartum hemorrhage. However, to date, only very limited data about maternal outcome after intra-abdominal packing for surgically uncontrolled hemorrhage following hysterectomy are available. The objective of the current study was to estimate maternal outcome after intra-abdominal packing following unsuccessful peripartum hysterectomy for postpartum hemorrhage.

Methods

A questionnaire was mailed to all maternity units performing more than 850 deliveries per year. Inclusion criteria were: all cases of abdominal packing performed following unsuccessful peripartum hysterectomy for postpartum hemorrhage between 2003 and 2013. The primary outcome was success of intra-abdominal packing, defined as the arrest of hemorrhage with no need of additional procedure.

Results

The total number of deliveries during the study period that occurred in the 51 participating centers was 1,430,142. The centers reported a total of 718 (1 per 2000 deliveries) peripartum hysterectomies for PPH and 53 abdominal packings performed after unsuccessful peripartum hysterectomy (about 1 per 14 hysterectomies). A median of 5 [IQR 3–7] pads were used for packing. Abdominal packing was removed after a median of 39.5 hours [IQR 24–48]. The success rate of abdominal packing was 62% (33/53). Among the 20 (38%) women in whom bleeding did not stop following the use of abdominal packing, 6 required a second surgical intervention, 6 a pelvic artery embolization and the 8 other women had “only” further intensive resuscitation and pharmacological treatments. Finally, mortality rate was 24% (13/53).

Conclusion

Our results suggest that abdominal packing, used for duration of 24 to 48 hours, seems to be an option as an ultimate procedure to control persistent life-threatening postpartum hemorrhage following peripartum hysterectomy.

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