Attitudes toward mode of hysterectomy: a survey-based study among German gynecologists

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Abstract

Objective

To determine the attitudes of Germany's gynecologists to mode of hysterectomy (HE) for benign indications.

Study design

In this cross-sectional study a postal questionnaire was sent to all members of the North-Eastern German Society of Gynecological Oncology (NOGGO) and the German Society of Psychosomatic Obstetrics and Gynecology (DGPFG). Questions examined attitudes to mode of HE based on three clinical scenarios with different conditions of the uterus. Gynecologists were also asked to estimate how the distribution of the different modes of HE for benign conditions should be. Analyses were performed with multiple logistic regression, chi-square tests and univariate nonparametric ANOVA. The main outcome measure was the analysis of current attitudes toward three well-defined settings regarding HE amongst German gynecologists.

Results

The response rate was 27%, giving a sample size of 354, and 36% (n = 128) of the gynecologists performed HE as part of their daily work. In this subgroup the following results were statistically significant. (1) Female gynecologists chose total vaginal hysterectomy (TVH) more often than male gynecologists. (2) With increasing professional experience of the female gynecologists the choice of TVH grew. (3) Gynecologists in private practice preferred laparoscopic-assisted vaginal hysterectomy (LAVH) compared to gynecologists in hospital. Personal choice of mode of HE varied significantly depending on the gender and place of work.

Conclusions

The preferred mode of HE varied significantly depending on gynecologist's gender, type of clinical setting and professional experience.

Introduction

Hysterectomy (HE) is one of the most frequently performed operations in gynecology. In 2010 in Germany 121,001 patients with benign changes of the uterus underwent HE. Of these patients, 61% were discharged from hospital following HE with the diagnosis ‘myoma’, and 13% with the diagnosis ‘endometriosis’ [1]. The past few years have not shown a significant decline in the number of HE performed, despite the fact that alternative treatment methods exist (e.g. hysteroscopic endometrial ablation, and embolization of myoma). A trend toward using different surgical approaches, however, has become apparent. The classic abdominal HE is increasingly being replaced by laparoscopic or laparoscopic-assisted methods as well as by the supracervical approach [2]. With regard to the choice of therapy, decisions are taken based on various factors including symptoms, risk-benefit analysis, patient's wishes and the experience of the physician. Such a decision should be participatory and not based on personal preference of the attending physician [3], [4].

Several studies in the USA and in Scandinavia investigated opinions of physicians and set out to determine which factors influence decision-making when it comes to HE [5], [6], [7], [8]. Results of a study by Persson et al. were published in 2009 [9]. The study aimed to investigate attitudes toward mode of HE among Swedish gynecologists and to analyze whether differences existed with respect to workplace, years in specialty, surgical experience and the gynecologist's gender. The results were then discussed in relation to the number of HE done per annum by the gynecological surgeons [9]. No similar studies have been conducted in Germany to date. Our study aims therefore not only to measure the current opinion of German gynecologists about aspects of HE using the Swedish questionnaire, but also to examine and compare the results collected in the respective countries.

Section snippets

Materials and methods

A translated and modified version of Persson's original questionnaire was sent to all members of both the North-Eastern German Gynecology Association (Nordostdeutsche Gesellschaft für Gynäkologische Onkologie, abbreviated: NOGGO) (n = 613) and the German Society for Psychosomatic Gynecology and Obstetrics (Deutsche Gesellschaft für Psychosomatische Frauenheilkunde und Geburtshilfe, abbreviated: DGPFG e.V.) (n = 785) in March and April 2010 with permission from the chairpersons of the two societies.

Results

In total 27% of the questionnaires were returned (378/1398). Of these, five were not completed. Questionnaires completed by gynecologists who themselves, or whose partners, had undergone HE were excluded (n = 19). Finally, 354 questionnaires (94%) were included in the evaluation (60% female gynecologists, 40% male gynecologists).

The mean age of participants was 50 y (range 27–84), and this was identical between female and male gynecologists. The participants had worked in the specialty for an

Comment

In our study, we found that the preferred mode of HE varied significantly depending on gynecologist's gender, type of clinical setting and professional experience.

Criticisms of our study could be made regarding the following. At 27%, the response rate was low. A possible reason for this is that some gynecologists do not perform HE. In our sample, one third of the participants performed HE themselves. Therefore, it would appear that the subject is of minor relevance for many gynecologists and

Conflicts of interest

All authors state explicitly that no conflicts of interest exist.

Acknowledgements

We would like to thank Pär Persson and colleagues for kindly letting us use their questionnaire and Jenny Lindholm for the translation of the questionnaire from Swedish. Furthermore, we thank the boards and members of DGPFG e.V. and NOGGO e.V. for their benevolent support.

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