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Age at hysterectomy as a predictor for subsequent pelvic organ prolapse repair.

https://arctichealth.org/en/permalink/ahliterature279451
Source
Int Urogynecol J. 2016 May;27(5):751-5
Publication Type
Article
Date
May-2016
Author
Rune Lykke
Jan Blaakær
Bent Ottesen
Helga Gimbel
Source
Int Urogynecol J. 2016 May;27(5):751-5
Date
May-2016
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Denmark - epidemiology
Female
Follow-Up Studies
Humans
Hysterectomy - adverse effects - statistics & numerical data
Incidence
Kaplan-Meier Estimate
Middle Aged
Pelvic Organ Prolapse - epidemiology - surgery
Registries
Risk factors
Abstract
The aim of this study was to investigate the association between patient age at the time of hysterectomy and subsequent pelvic organ prolapse (POP) surgery.
We gathered data on all benign hysterectomies and POP surgeries performed in Denmark on Danish women from 1977 to 2009 from the Danish National Patient Registry. The cohort consisted of 154,882 hysterectomized women, who were followed up for up to 32 years. Survival analysis for each age group at hysterectomy was performed using Kaplan-Meier product limit methods.
For all hysterectomized women, we found that low age at hysterectomy yielded a lower risk of subsequent POP surgery than did hysterectomy at an older age. This difference diminished after stratification by indication; all non-POP hysterectomies had a low cumulative incidence at 8-11 % at the end of the follow-up period. For all women hysterectomized, the predominant compartment for POP surgery was the posterior. Women hysterectomized when aged over 66 years had a higher proportion of POP surgery in the apical compartment than in the other age groups (p?=?0.000).
Our findings indicate that age at hysterectomy only marginally influences the risk of subsequent POP surgery for women hysterectomized for indications other than POP. If POP is the indication for hysterectomy, the risk of undergoing subsequent POP surgery increases substantially.
PubMed ID
26564221 View in PubMed
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Source
Ugeskr Laeger. 2012 Oct 15;174(42):2524
Publication Type
Article
Date
Oct-15-2012
Author
Annette Settnes
Signe Daugbjerg
Bent Ottesen
Author Affiliation
Gynækologisk Afdeling, Hillerød Hospital, Dyrehavevej 29, Hillerød. aset@noh.regionh.dk
Source
Ugeskr Laeger. 2012 Oct 15;174(42):2524
Date
Oct-15-2012
Language
Danish
Publication Type
Article
Keywords
Databases, Factual
Denmark
Female
Humans
Hysterectomy - adverse effects - statistics & numerical data
Postoperative Complications - epidemiology
Quality Assurance, Health Care
Registries
PubMed ID
23079427 View in PubMed
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FINHYST, a prospective study of 5279 hysterectomies: complications and their risk factors.

https://arctichealth.org/en/permalink/ahliterature134807
Source
Hum Reprod. 2011 Jul;26(7):1741-51
Publication Type
Article
Date
Jul-2011
Author
Tea H I Brummer
Jyrki Jalkanen
Jaana Fraser
Anna-Mari Heikkinen
Minna Kauko
Juha Mäkinen
Tomi Seppälä
Jari Sjöberg
Eija Tomás
Päivi Härkki
Author Affiliation
Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Finland. tea.brummer@hus.fi
Source
Hum Reprod. 2011 Jul;26(7):1741-51
Date
Jul-2011
Language
English
Publication Type
Article
Keywords
Adult
Blood Loss, Surgical
Female
Finland
Humans
Hysterectomy - adverse effects - statistics & numerical data
Hysterectomy, Vaginal - adverse effects
Incidence
Intraoperative Complications - epidemiology
Middle Aged
Multivariate Analysis
Postoperative Complications - epidemiology - microbiology - pathology
Prospective Studies
Regression Analysis
Risk factors
Urinary Tract - injuries
Abstract
Hysterectomy guidelines highlight an increase in urinary tract injuries with laparoscopic hysterectomy (LH). This national survey analyses complications of LH, abdominal hysterectomy (AH) and vaginal hysterectomy (VH).
A prospective cohort undergoing hysterectomy for benign indications during 2006 was drawn from 53 hospitals in Finland; all communal hospitals participated. Detailed questionnaires covered surgical data and intra- and post-operative major and minor complications, for which risk factors were analysed by a multivariate logistic regression model adjusted for surgical data and patient characteristics.
Major complications rates in AH (n= 1255, 24%), LH (1679, 32%) and VH (2345, 44%) were 4.0, 4.3 and 2.6%, and total complications rates were 19.2, 15.4 and 11.7%, respectively. Logistic regression showed no statistically significant differences between approaches for any organ injuries or other major complications. Most bladder and bowel injuries (88 and 83%), but not ureter injuries (10%), were recognized intra-operatively. The ureter injury rate was low after LH (0.3%), as it was after other types of hysterectomy. Compared with LH, AH increased the odds of wound infection, and was an independent risk factor for urinary infections and febrile events. Compared with AH, LH and VH both presented a higher risk for pelvic infection; surgically treated equally often regardless of the type of hysterectomy. No differences in complications emerged between LH and VH. Obesity was a risk factor for many infections. Surgical adhesiolysis [odds ratio (OR) 2.41, 95% confidence interval (CI) 1.38-4.21] was the strongest single risk factor for major complications as a whole. Bladder injury was associated with a history of caesarean section (OR 4.01, 95% CI 2.06-7.83) and with a large uterus =500 g (OR 2.88, 95% CI 1.05-7.90), while bowel injury was associated with adhesiolysis (OR 29.07, 95% CI 7.17-117.88).
FINHYST is a large prospective hysterectomy study illustrating actual complications. Whenever possible, hysterectomy should be minimally invasive.
PubMed ID
21540244 View in PubMed
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Hysterectomy and risk of cardiovascular disease: a population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature138360
Source
Eur Heart J. 2011 Mar;32(6):745-50
Publication Type
Article
Date
Mar-2011
Author
Erik Ingelsson
Cecilia Lundholm
Anna L V Johansson
Daniel Altman
Author Affiliation
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, SE-171 77 Stockholm, Sweden.
Source
Eur Heart J. 2011 Mar;32(6):745-50
Date
Mar-2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Cardiovascular Diseases - epidemiology - etiology
Cohort Studies
Coronary Disease - epidemiology - etiology
Female
Humans
Hysterectomy - adverse effects - statistics & numerical data
Incidence
Middle Aged
Ovariectomy - adverse effects - statistics & numerical data
Risk factors
Stroke - epidemiology - etiology
Sweden - epidemiology
Young Adult
Abstract
Hysterectomy for benign indications is one of the commonest surgical procedures in women, but the association between the procedure and cardiovascular disease (CVD) is not fully understood. In this population-based cohort study, we studied the effects of hysterectomy, with or without oopherectomy, on the risk of later life CVD.
Using nationwide healthcare registers, we identified all Swedish women having a hysterectomy on benign indications between 1973 and 2003 (n = 184,441), and non-hysterectomized controls (n = 640,043). Main outcome measure was the first hospitalization or death of incident CVD (coronary heart disease, stroke, or heart failure). Occurrence of CVD was determined by individual linkage to the Inpatient Register. In women below age 50 at study entry, hysterectomy was associated with a significantly increased risk of CVD during follow-up [hazard ratio (HR), 1.18, 95% confidence interval (CI), 1.13-1.23; HR, 2.22, 95% CI, 1.01-4.83; and HR, 1.25, 95% CI, 1.06-1.48; in women without oopherectomy, with oopherectomy before or at study entry, respectively, using women without hysterectomy or oopherectomy as reference]. In women aged 50 or above at study entry, there were no significant associations between hysterectomy and incident CVD.
Hysterectomy in women aged 50 years or younger substantially increases the risk for CVD later in life and oopherectomy further adds to the risk of both coronary heart disease and stroke.
PubMed ID
21186237 View in PubMed
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Hysterectomy and subsequent risk of cancer.

https://arctichealth.org/en/permalink/ahliterature208295
Source
Int J Epidemiol. 1997 Jun;26(3):476-83
Publication Type
Article
Date
Jun-1997
Author
R. Luoto
A. Auvinen
E. Pukkala
M. Hakama
Author Affiliation
National Public Health Institute, Department of Epidemiology and Health Promotion, Helsinki, Finland.
Source
Int J Epidemiol. 1997 Jun;26(3):476-83
Date
Jun-1997
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Chi-Square Distribution
Cohort Studies
Confidence Intervals
Female
Finland - epidemiology
Genital Neoplasms, Female - epidemiology
Humans
Hysterectomy - adverse effects - statistics & numerical data
Middle Aged
Neoplasms - epidemiology
Rectal Neoplasms - epidemiology
Registries
Retrospective Studies
Risk
Thyroid Neoplasms - epidemiology
Time Factors
Abstract
The objective of this retrospective cohort study was to assess the effect of hysterectomy on subsequent risk of cancer among 25,382 hysterectomized and a similar number of non-hysterectomized control women, registered in 1963-1976 in the Mass Screening Registry (MSR).
Cancer cases were obtained from the Finnish Cancer Registry (FCR) and standardized incidence ratio (SIR); the expected number of cases based on cancer incidence rates of the Finnish female population in 1967-1993, was used. Relative risk (RR) was calculated as SIR among the hysterectomized relative to non-hysterectomized women, adjusted for follow-up, education and parity.
The RR estimates of non-genital cancers among women with any hysterectomy were approximately 5% higher than in the non-hysterectomized cohort. Relative risks of rectal cancer (RR = 1.4, 95% confidence interval [CI]: 1.0-1.8) and thyroid cancer (RR = 2.1, 95% CI; 1.5-3.1) were significant and largest among women who had undergone total hysterectomy pre- or perimenopausally. Relative risk estimates of breast cancer were close to unity.
Hysterectomy is not associated with any substantial protective or promoting effect on cancers in general. Elevated risk of papillary thyroid cancer following hysterectomy is biologically plausible, as there are reproductive and endocrinological causes of thyroid cancer.
PubMed ID
9222770 View in PubMed
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Incidence of ovarian cancer after hysterectomy: a nationwide controlled follow up.

https://arctichealth.org/en/permalink/ahliterature21877
Source
Br J Obstet Gynaecol. 1997 Nov;104(11):1296-301
Publication Type
Article
Date
Nov-1997
Author
A. Loft
O. Lidegaard
A. Tabor
Author Affiliation
Department of Obstetrics and Gynaecology at Rigshospitalet, University of Copenhagen, Denmark.
Source
Br J Obstet Gynaecol. 1997 Nov;104(11):1296-301
Date
Nov-1997
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Cohort Studies
Denmark - epidemiology
Female
Follow-Up Studies
Humans
Hysterectomy - adverse effects - statistics & numerical data
Incidence
Infant
Infant, Newborn
Middle Aged
Ovarian Neoplasms - epidemiology
Ovariectomy - statistics & numerical data
Prospective Studies
Research Support, Non-U.S. Gov't
Risk factors
Time Factors
Abstract
OBJECTIVE: To estimate the risk of developing ovarian cancer after abdominal (total or subtotal) hysterectomy on benign indication. DESIGN: Prospective historical cohort study with 12.5 years of follow up. SETTING: Denmark, nationwide. POPULATION: All Danish women (aged 0 to 99 years) having undergone hysterectomy with conservation of at least one ovary for a benign indication from 1977 to 1981 (n = 22,135). Follow up was conducted from 1977 to 1991. The reference group included all Danish women who had not undergone hysterectomy, age-standardised according to the hysterectomy group (n = 2,554,872). METHODS: Registry data derived from the Danish National Register of Patients (diagnoses and operation codes) and the Civil Registration System (information about general population, including time of death). MAIN OUTCOME MEASURES: Incidence rate of ovarian cancer, lifetime risk of ovarian cancer, relative risk of ovarian cancer. RESULTS: Seventy-one women developed ovarian cancer on average 7.0 years after hysterectomy and 10,659 women in the reference group had ovarian cancer diagnosed after on average 6.4 years. The incidence rate of ovarian cancer was 0.27 per 1000 person-years in the group that had undergone hysterectomy and 0.34 per 1000 person-years in the general population (age-standardised). The extrapolated lifetime risk of developing ovarian cancer was 2.1% after hysterectomy and 2.7% in the general population (RR 0.78; 95% CI 0.60-0.96). CONCLUSIONS: The risk of ovarian cancer is lower among women who have undergone hysterectomy compared with those who have not. The protection seems to decrease with time.
PubMed ID
9386032 View in PubMed
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Influence of hysterectomy on fistula formation in women with diverticulitis.

https://arctichealth.org/en/permalink/ahliterature146489
Source
Br J Surg. 2010 Feb;97(2):251-7
Publication Type
Article
Date
Feb-2010
Author
D. Altman
C. Forsgren
F. Hjern
C. Lundholm
S. Cnattingius
A L V Johansson
Author Affiliation
Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden. daniel.altman@ki.se
Source
Br J Surg. 2010 Feb;97(2):251-7
Date
Feb-2010
Language
English
Publication Type
Article
Keywords
Case-Control Studies
Diverticulitis - epidemiology - surgery
Female
Fistula - epidemiology - etiology
Hospitalization - statistics & numerical data
Humans
Hysterectomy - adverse effects - statistics & numerical data
Intestinal Fistula - epidemiology - etiology
Risk factors
Sweden - epidemiology
Urinary Fistula - epidemiology - etiology
Vaginal Fistula - epidemiology - etiology
Abstract
: Diverticulitis is a risk factor for fistula formation but little is known about the influence of hysterectomy in this association. A population-based nationwide matched cohort study was performed to determine the risk of fistula formation in hysterectomized women with, and without, diverticulitis.
: Women who had a hysterectomy between 1973 and 2003, and a matched control cohort, were identified from the Swedish Inpatient Register. Incidence of diverticulitis and fistula surgery was determined by cross-linkage to the Register, and risk was estimated using a Cox regression model.
: In a cohort of 168 563 hysterectomized and 614 682 non-hysterectomized women (mean follow-up 11.0 and 11.5 years respectively), there were 14 051 cases of diverticulitis and 851 fistulas. Compared with women who had neither hysterectomy nor diverticulitis, the risk of fistula surgery increased fourfold in hysterectomized women without diverticulitis (hazard ratio (HR) 4.0 (95 per cent confidence interval (c.i.) 3.5 to 4.7)), sevenfold in non-hysterectomized women with diverticulitis (HR 7.6 (4.8 to 12.1)) and 25-fold in hysterectomized women with diverticulitis (HR 25.2 (15.5 to 41.2)).
: Diverticulitis, and to a lesser extent hysterectomy, is strongly associated with the risk of fistula formation. Hysterectomized women with diverticulitis have the highest risk of developing surgically managed fistula.
PubMed ID
20035535 View in PubMed
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National learning curve for laparoscopic hysterectomy and trends in hysterectomy in Finland 2000-2005.

https://arctichealth.org/en/permalink/ahliterature159044
Source
Hum Reprod. 2008 Apr;23(4):840-5
Publication Type
Article
Date
Apr-2008
Author
Tea H I Brummer
Tomi T Seppälä
Päivi S M Härkki
Author Affiliation
Department of Obstetrics and Gynecology, Helsinki University Central Hospital, PO Box 140, Helsinki, 00029 HUS, Finland. tea.brummer@hus.fi
Source
Hum Reprod. 2008 Apr;23(4):840-5
Date
Apr-2008
Language
English
Publication Type
Article
Keywords
Female
Finland
Humans
Hysterectomy - adverse effects - statistics & numerical data - trends
Laparoscopy - adverse effects - statistics & numerical data - trends
Postoperative Complications - epidemiology
Retrospective Studies
Abstract
Complications of laparoscopic hysterectomy (LH) have been evaluated with particular focus on quantities of urinary tract injuries. An earlier survey in the 1990s on LH in Finland indicated a decreasing trend in complications; our aim was to evaluate the current complications and hysterectomy trends.
All hysterectomies in Finland performed for benign indication from 2000 to 2005 (n = 56 130) were included, data were obtained from the Finnish hospital care register. All major complications reported on LH were analysed; the data were collected retrospectively from the Patient Insurance Centre.
In 2000, the proportion of abdominal hysterectomy (AH) was 38%, vaginal hysterectomy (VH) 37% and LH 25%, whereas in 2005, the proportions were 26%, 45% and 29%, respectively. The overall incidence of major complications in LHs from 1992 to 1999 (LH n = 13 885) was 1.8% and from 2000 to 2005 (LH n = 13 942) it decreased to 1.0%. During the same time, urinary tract injuries decreased from 1.4% to 0.7%; in detail ureteral injuries decreased from 0.9% to 0.3%.
Laparoscopic and VHs have become more common in Finland than AH. Continuous instruction and training of the Finnish gynaecological surgeons has helped to diminish major complication rates and it seems that in LH, a plateau on the learning curve has been reached.
PubMed ID
18238905 View in PubMed
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[Ovarian function after premenopausal hysterectomy]

https://arctichealth.org/en/permalink/ahliterature54969
Source
Ugeskr Laeger. 1993 Nov 22;155(47):3818-22
Publication Type
Article
Date
Nov-22-1993
Author
L. Nilas
A. Loft
Author Affiliation
Gynaekologisk-obstetrisk afdeling, Hvidovre Hospital, København.
Source
Ugeskr Laeger. 1993 Nov 22;155(47):3818-22
Date
Nov-22-1993
Language
Danish
Publication Type
Article
Keywords
Adult
Climacteric
Coronary Disease - etiology
English Abstract
Female
Humans
Hysterectomy - adverse effects - statistics & numerical data
Menopause
Ovary - physiopathology
Risk factors
Abstract
In Denmark, about 6000 hysterectomies are performed annually, and about 75% are performed on benign indications in women less than 50 years of age. When deciding on oophorectomia per occasionem, the risk of disease in the retained ovaries must be weighed against the advantages of continued ovarian function. The literature about ovarian function after hysterectomy consists predominantly of older, retrospective and uncontrolled investigations describing earlier menopause, increased frequency of climacteric symptoms and increased risk of benign ovarian cysts. Hysterectomy is followed by histological changes in the retained ovaries, but a significant reduction in the ovarian hormone production is not documented. Several studies have indicated that hysterectomy is followed by an increased risk of ischaemic heart disease, but the literature is equivocal. A possible explanation for the altered ovarian function after hysterectomy is reduced ovarian blood supply caused by the operation, but the existence of a direct endocrine function of the uterus can not be excluded. Solid prospective studies of the ovarian function following hysterectomy are needed.
Notes
Comment In: Ugeskr Laeger. 1994 Feb 21;156(8):11568116100
PubMed ID
8256381 View in PubMed
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Pelvic organ prolapse (POP) surgery among Danish women hysterectomized for benign conditions: age at hysterectomy, age at subsequent POP operation, and risk of POP after hysterectomy.

https://arctichealth.org/en/permalink/ahliterature269917
Source
Int Urogynecol J. 2015 Apr;26(4):527-32
Publication Type
Article
Date
Apr-2015
Author
Rune Lykke
Jan Blaakær
Bent Ottesen
Helga Gimbel
Source
Int Urogynecol J. 2015 Apr;26(4):527-32
Date
Apr-2015
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Denmark
Female
Follow-Up Studies
Humans
Hysterectomy - adverse effects - statistics & numerical data
Kaplan-Meier Estimate
Middle Aged
Pelvic Organ Prolapse - surgery
Registries
Risk factors
Time Factors
Abstract
The aim of this study was to describe the incidence of pelvic organ prolapse (POP) surgery after hysterectomy from 1977 to 2009, the time interval from hysterectomy to POP surgery, and age characteristics of women undergoing POP surgery after hysterectomy and to estimate the risk of undergoing POP surgery after hysterectomy.
The study was a population-based registry study. Patient data from 154,882 women hysterectomized for benign conditions in the period from 1977 to 2009 were extracted from the Danish National Patient Registry. Patients were followed up from hysterectomy to POP surgery, death/emigration, or end of study period. An estimate of the hazard of undergoing POP surgery following hysterectomy was calculated. Survival analysis was performed using the Kaplan-Meier product limit method.
The frequency of POP surgery on hysterectomized women was high the first 2 years of the follow-up period with almost 800 women operated yearly. More than one third (n?=?2,872) of all women operated for POP were operated less than 5 years after the hysterectomy with a median of 8.6 years. The cumulated incidence of POP surgery after hysterectomy with follow-up of up to 32 years was 12 %; 50 % (n?=?5,451) of all POP surgeries were in the posterior compartment. The mean age of women undergoing a first POP surgery after hysterectomy was 60 years.
POP after hysterectomy occurs as a long-term complication of hysterectomy; 12 % of hysterectomized women were operated for POP. They were operated at younger age than non-hysterectomized women and half the POP operations were performed in the posterior compartment.
PubMed ID
25182152 View in PubMed
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11 records – page 1 of 2.