Duration of Sick Leave, Patientʼs Postoperative Satisfaction and Impairment of Daily Living after Open Abdominal Myoma Enucleation in Dependence on Myoma Size

 

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Abstract

Purpose: What is the average duration of sick leave and the postoperative impairment to daily living in dependence on the size of the removed myoma? Does patient satisfaction depend on the size of the removed myoma? Is there a difference in the rate of improvement of symptoms depending on the size of the myoma? Patient Collective: This is a retrospective survey of the data of 377 consecutive female patients treated for symptomatic uterus myomatosus by open abdominal myoma enucleation between 2/2002 and 12/2009; the number of removed myomas, myoma size and localisation, myoma-associated complaints, length of sick leave, postoperative impairments of daily living and scar length were assessed. Results: The response rate amounted to 61 % (230/377 patients). The average sick leave of patients with a myoma diameter ≥ 10 cm was 1.5 days shorter than that for patients with myomas < 10 cm. Depending on the symptoms between 7 and 75 % of the patients reported an improvement of their complaints. For those patients with myomas > 10 cm the proportion with an improvement in symptoms was smaller than that for the patients with smaller myomas – exception “feeling of pressure in the bladder”. Conclusions: Even for relatively large myomas, the quality of life is not impaired more strongly or for longer periods than that after removal of smaller myomas. Activities of daily life are impaired for about 4 weeks.

Zusammenfassung

Fragestellung: Wie ist die durchschnittliche Krankschreibungsdauer und Beeinträchtigung des täglichen Lebens postoperativ je nach Größe des entfernten Myoms? Hängt die Patientinnenzufriedenheit von der Größe des entfernten Myoms ab? Unterscheidet sich die Häufigkeit der Beschwerdebesserung in Abhängigkeit von der Myomgröße? Patientinnenkollektiv: Monozentrische retrospektive Datenauswertung von 377 konsekutiv von 2/2002 bis 12/2009 wegen eines symptomatischen Uterus myomatosus mittels abdominal-offener Myomenukleation operierten Frauen; Erfassung der Anzahl der entfernten Myome, Myomgröße und -lokalisation, myomassoziierten Beschwerden, Krankschreibungsdauer, postoperativen Beeinträchtigung der täglichen Lebensführung, Narbenlänge. Ergebnisse: Die Rücklaufquote betrug 61 % (230/377 Pat.). Patientinnen mit einem Myomdurchmesser ≥ 10 cm waren 1,5 Tage kürzer krankgeschrieben als die Patientinnen mit Myomen < 10 cm. Eine Beschwerdebesserung gaben, je nach Symptom, 7 bis 75 % der Patientinnen an. Bei den Patientinnen mit Myomen > 10 cm war der Anteil von Frauen mit Symptombesserung geringer als bei den Patientinnen mit kleineren Myomen – Ausnahme „Druckgefühl auf die Blase“. Schlussfolgerungen: Auch bei relativ großen Myomen ist nach abdominal-offener Enukleation die Lebensqualität nicht stärker oder länger gemindert als bei der Entfernung kleinerer Myome. Die tägliche Lebensführung ist für etwa 4 Wochen beeinträchtigt.

• References

• 1 Reitsma ML, Vandenkerkhof EG, Johnston SL et al. Does health-related quality of life improve in women following gynaecological surgery. J Obstet Gynaecol Can 2011; 33: 1241-1247
  CrossrefPubMedGoogle Scholar
• 2 Baird DD, Dunson DB, Hill MC et al. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 2003; 188: 100-107
  CrossrefPubMedGoogle Scholar
• 3 Buttram VC, Reiter RC. Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril 1981; 36: 433-445
  PubMedGoogle Scholar
• 4 Gupta S, Jose J, Manyonda I. Clinical presentation of fibroids. Best Pract Res Clin Obstet Gynaecol 2008; 22: 615-626
  CrossrefPubMedGoogle Scholar
• 5 Borah BJ, Nicholson WK, Bradley L et al. The impact of uterine leiomyomas: a national survey of affected women. Am J Obstet Gynecol 2013; 209: 319.e1-319.e20
  CrossrefPubMedGoogle Scholar
• 6 Péréz-López FR, Ornat L, Ceausu I et al. EMAS position statement: management of uterine fibroids. Maturitas 2014; 79: 106-116
  CrossrefPubMedGoogle Scholar
• 7 Harding G, Coyne KS, Thompson CL et al. The responsiveness of the uterine fibroid symptom and health-related quality of life questionnaire (UFS-QOL). Health Qual Life Outcomes 2008; 6: 99
  CrossrefPubMedGoogle Scholar
• 8 Scheurig-Münkler C, David M, Kröncke TJ. Uterusarterienembolisation bei Patientinnen mit symptomatischen Gebärmuttermyomen: prospektive Studie zu klinischem Erfolg und Veränderung der Lebensqualität im langfristigen Verlauf. Geburtsh Frauenheilk 2011; 71: 653-658
  Article in Thieme ConnectPubMedGoogle Scholar
• 9 Darwish M, Atlantis E, Mohamed-Taysir T. Psychological outcomes after hysterectomy for benign conditions: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2014; 174: 5-19
  CrossrefPubMedGoogle Scholar
• 10 Horng HC, Wen KC, Su WH et al. Review of myomectomy. Taiwan J Obstet Gynecol 2012; 51: 7-11
  CrossrefPubMedGoogle Scholar
• 11 Jonmarker S, Valdman A, Lindberg A et al. Tissue shrinkage after fixation with formalin injection of prostatectomy specimens. Virchows Arch 2006; 449: 297-301
  CrossrefPubMedGoogle Scholar
• 12 Clayton M, Verow P. A retrospective study of return to work following surgery. Occup Med (Lond) 2007; 57: 525-531
  CrossrefPubMedGoogle Scholar
• 13 Pundir J, Krishnan N, Siozos A et al. Peri-operative morbidity associated with abdominal myomectomy for very large fibroid uteri. Eur J Obstet Gynecol Reprod Biol 2013; 167: 219-224
  CrossrefPubMedGoogle Scholar
• 14 Oladapo OT, Akinsanya AF. Relative morbidity of abdominal myomectomy for very large uterine fibroids in a developing country hospital. Arch Gynecol Obstet 2011; 283: 825-830
  CrossrefPubMedGoogle Scholar
• 15 Goodwin SC, Bradley LD, Lipman JC et al. Uterine artery embolization versus myomectomy: a multicenter comparative study. Fertil Steril 2006; 85: 14-21
  PubMedGoogle Scholar
• 16 Wang X, Qin J, Wang L et al. Effect of high-intensity focused ultrasound on sexual function in the treatment of uterine fibroids: comparison to conventional myomectomy. Arch Gynecol Obstet 2013; 288: 851-858
  CrossrefPubMedGoogle Scholar
• 17 Razavi MK, Hwang G, Jahed A et al. Abdominal myomectomy versus uterine fibroid embolization in the treatment of symptomatic uterine leiomyomas. AJR 2003; 180: 1571-1575
  CrossrefPubMedGoogle Scholar
• 18 Evenson M, Payne D, Nygaard I. Recovery at home after major gynecologic surgery: How do our patients fare?. Obstet Gynecol 2012; 119: 780-784
  CrossrefPubMedGoogle Scholar
• 19 Wen KC, Sung PL, Chao KC et al. A prospective short-term evaluation of uterine leiomyomas treated by myomectomy through conventional laparotomy or ultraminilaparotomy. Fertil Steril 2008; 90: 2361-2366
  CrossrefPubMedGoogle Scholar
• 20 Broder MS, Goodwin S, Chen G et al. Comparison of long-term outcomes of myomectomy and uterine artery embolization. Obstet Gynecol 2002; 100: 864-868
  CrossrefPubMedGoogle Scholar
• 21 Mara M, Maskova J, Fucikova Z et al. Midterm clinical and first reproductive results of a randomized controlled trial comparing uterine fibroid embolization and myomectomy. Cardiovascul Intervent Radiol 2008; 31: 73-85
  PubMedGoogle Scholar
• 22 Siskin GP, Shlansky-Goldberg RD, Goodwin SC et al. A prospective multicenter comparative study between myomectomy and uterine artery embolization with polyvinyl alcohol microspheres: long-term clinical outcomes in patients with symptomatic uterine fibroids. J Vasc Interv Radiol 2006; 17: 1287-1295
  CrossrefPubMedGoogle Scholar
• 23 Koch K, Schürmann C, Sawicki P. Das deutsche Gesundheitswesen im internationalen Vergleich. Dtsch Arztebl Int 2010; 107: 427-434
  PubMedGoogle Scholar
• 24 Spies JB, Coyne K, Guaou Guaou N et al. The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstet Gynecol 2002; 99: 290-300
  CrossrefPubMedGoogle Scholar
• 25 Vonk Noordegraaf A, Anema JR, Louwerse MD et al. Prediction of time to return to work after gynaecological surgery: a prospective cohort study in the Netherlands. BJOG 2014; 121: 487-497
  CrossrefPubMedGoogle Scholar

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