A prospective cohort study of the clinical management of total abdominal hysterectomy for benign disease

Summary

This study describes the clinical management of women undergoing total abdominal hysterectomy, identifies aspects of care that could be improved and variations in clinical practice that require evaluation. A cohort of 366 women undergoing surgery for non-malignant disease in six hospitals completed questionnaires before, 10 days and 6 weeks after their operation. Data were also extracted from hospital case notes and senior ward nurses were interviewed.

Aspects of care that could be improved included use of prophylactic antibiotics (only 60 per cent) and single unit transfusions (6 per cent), legibility and completeness of case notes (20 per cent had no histology report), early postoperative mobilisation (29 per cent not sitting out on first day), prescription of hormone replacement therapy (24 per cent not prescribed), discharge delays (up to 21 per cent in one hospital), and better information for patients (27 per cent dissatisfied). Aspects of clinical practice that varied and require evaluation include prophylactic oophorectomy (particularly in younger women), wound closure methods and use of postoperative indwelling catheters.