CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2021; 81(02): 200-213
DOI: 10.1055/a-1263-0811
GebFra Science
Review

The Impact of Preoperative Assessment and Planning on the Outcome of Benign Hysterectomy – a Systematic Review

Auswirkung von präoperativer Untersuchung und Planung auf das Outcome nach benigner Hysterektomie – ein systematischer Überblick
Lollo Makdessi Björkström
1   Department of Obstetrics and Gynecology in Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
,
Ninnie Borendal Wodlin
2   Department of Obstetrics and Gynecology in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
,
Lena Nilsson
3   Department of Anesthesiology and Intensive Care in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping
,
Preben Kjølhede
2   Department of Obstetrics and Gynecology in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Abstract

Knowledge concerning the impact of preoperative planning, patient information and patient factors on the outcome of benign hysterectomy is incomplete. This systematic review summarizes the current knowledge on the effect of preoperative planning and of preoperative patient factors on the outcome of benign hysterectomy. The PubMed/PubMed Central/MEDLINE, Scopus, Web of Science, TRIP Medical Database, Prospero and the Cochrane Library databases were searched. Inclusion criteria were prospective trials, hysterectomy for benign disease, systematic preoperative assessment, and article in English. Eighteen articles were included and categorized according to their main aims: use of a preoperative checklist, preoperative decision-making, preoperative information, and the effect on the outcome of surgery of factors that concerns patients preoperatively. Focused and well directed preoperative assessment and thoroughness in the preoperative decision-making was associated with positive postoperative outcomes. The use of a checklist reduced the overall rate of hysterectomy and increased the use of minimally invasive surgery. Women were often inadequately informed before hysterectomy about the possible side effects after surgery. Preoperative anxiety and preoperative pain were associated with postoperative pain and lower quality of life. The indication for surgery had an impact on the reported quality of life postoperatively. The extent of preoperative planning seemed to affect the outcome of surgery. Preoperative patient factors influenced the postoperative recovery. Prehabilitation measures need further development and should be integrated in the preoperative planning. Prospective studies are warranted to evaluate and improve the preoperative planning in a systematic setting before performing hysterectomy for benign disease.

Zusammenfassung

Das Wissen um die Auswirkung von präoperativer Planung und Patientenaufklärung sowie von patientenbezogenen Faktoren auf das Outcome nach benigner Hysterektomie ist unvollständig. Diese systematische Übersichtsarbeit fasst den aktuellen Wissensstand über die Auswirkung von präoperativer Planung und präoperativen patientenbezogenen Faktoren auf das Outcome nach benigner Hysterektomie zusammen. Es wurde zunächst eine Suche in den Datenbanken PubMed/PubMed Central/MEDLINE, Scopus, Web of Science, TRIP Medical Database, Prospero und the Cochrane Library durchgeführt. Die Einschlusskriterien waren: prospektive Studie, Hysterektomie bei benigner Erkrankung, systematische präoperative Untersuchung, Artikel in englischer Sprache. Insgesamt wurden 18 Artikel in die Studie aufgenommen und nach ihren wesentlichen Zielen kategorisiert, wie folgt: Verwendung einer präoperativen Checkliste, präoperative Entscheidungsfindung, präoperative Aufklärung, die Auswirkung von patientenbezogenen präoperativen Faktoren auf das Outcome nach dem erfolgten Eingriff. Zielgerichtete präoperative Untersuchungen und eine gründliche und sorgfältige präoperative Entscheidungsfindung waren mit positiven postoperativen Ergebnissen assoziiert. Die Verwendung einer Checkliste verringerte die Gesamtrate an Hysterektomien und erhöhte die Anzahl minimalinvasiver Eingriffe. Frauen wurden vor der Hysterektomie oft nur unzureichend über die möglichen Nebenwirkungen des Eingriffs aufgeklärt. Präoperative Angst und präoperative Schmerzen waren mit postoperativen Schmerzen und geringer Lebensqualität verbunden. Die Indikation für den Eingriff hatte auch einen Einfluss auf die beschriebene Lebensqualität nach der Operation. Das Ausmaß an präoperativer Planung beeinflusste das Ergebnis nach der Hysterektomie. Präoperative patientenbezogene Faktoren wirkten sich auf die postoperative Heilung aus. Der Einsatz gezielter Aufbaumaßnahmen vor chirurgischen Eingriffen sollte ausgebaut und in die präoperative Planung integriert werden. Prospektive Studien sind gefragt, um die präoperative Planung vor Hysterektomien bei benigner Erkrankung systematisch auszuwerten und zu verbessern.

Key words

benign hysterectomy - preoperative planning - ERAS

Schlüsselwörter

benigne Hysterektomie - präoperative Planung - ERAS


Publikationsverlauf

Eingereicht: 21. April 2020

Angenommen: 13. September 2020

Artikel online veröffentlicht:
08. Februar 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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