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Ten years of progress--improved hysterectomy outcomes in Finland 1996-2006: a longitudinal observation study.

ABSTRACT: To study the outcome of various hysterectomies in 2 years 1996 (N =10110) and 2006 (N=5279). The hypothesis was that the change in operative practices in 10 years has resulted in improvements.2 prospective nationwide cohort evaluations with the same questionnaire.All national operative hospitals in Finland.Patients scheduled to either abdominal hysterectomy (AH), vaginal hysterectomy (VH) or laparoscopic hysterectomy (LH) for benign disease.Patients' characteristics, surgery-related details and complications (organ injury, infection, venous thromboembolism and haemorrhage).The overall complication rates fell in LH and markedly in VH (from 22.2% to 11.7%, p<0.001). The overall surgery-related infectious morbidity decreased in all groups and significantly in VH (from 12.3% to 5.2%, p<0.001) and AH (from 9.9% to 7.7%, p<0.05). The incidence of bowel lesions in VH sank from 0.5% to 0.1% and of ureter lesions in LH from 1.1% to 0.3%. In 2006 there were no deaths compared with three in 1996.The rate of postoperative complications fell markedly in the decade from 1996 to 2006. This parallels with the recommendation of the recent meta-analyses by Cochrane collaboration; the order of preference of hysterectomies was for the first time precisely followed in this nationwide study.The 2006 study was registered in the Clinical Trials of Protocol Registration System Data (NCT00744172).

SUBMITTER: Makinen J

PROVIDER: S-EPMC3816230 | biostudies-literature | 2013 Oct

REPOSITORIES: biostudies-literature

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Ten years of progress--improved hysterectomy outcomes in Finland 1996-2006: a longitudinal observation study.

Mäkinen Juha J Brummer Tea T Jalkanen Jyrki J Heikkinen Anna-Mari AM Fraser Jaana J Tomás Eija E Härkki Päivi P Sjöberg Jari J

BMJ open 20131028 10

<h4>Objectives</h4>To study the outcome of various hysterectomies in 2 years 1996 (N =10110) and 2006 (N=5279). The hypothesis was that the change in operative practices in 10 years has resulted in improvements.<h4>Design</h4>2 prospective nationwide cohort evaluations with the same questionnaire.<h4>Setting</h4>All national operative hospitals in Finland.<h4>Participants</h4>Patients scheduled to either abdominal hysterectomy (AH), vaginal hysterectomy (VH) or laparoscopic hysterectomy (LH) for ...[more]

PMID: 24165027

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Project description:BackgroundChina launched a new round of healthcare-system reform in 2009 and proposed the goal of equal and guaranteed essential medical and health services for all by 2020. We aimed to investigate the changes in China's health resources over the past ten years after the healthcare reform.MethodsData were collected from the China Statistical Yearbook and China Health Statistics Yearbook from 2009 to 2018. Four categories and ten indicators of health resources were analyzed. A descriptive analysis was used to present the overall condition. The Health Resource Density Index was applied to showcase health-resource distribution in demographic and geographic dimensions. The global and local Moran's I were used to assess the spatial autocorrelation of health resources. Concentration Index (CI) was used to quantify the equity of health-resource distribution. A Geo-Detector model and Geographic Weighted Regression (GWR) were applied to assess the association between gross domestic product (GDP) per capita and health resources.ResultsHealth resources have increased over the past ten years. The global and local Moran's I suggested spatial aggregation in the distribution of health resources. Hospital beds were concentrated in wealthier areas, but this inequity decreased yearly (from CI=0.0587 in 2009 to CI=0.0021 in 2018). Primary medical and health institutions (PMHI) and their beds were concentrated in poorer areas (CI remained negative). Healthcare employees were concentrated in wealthier areas (CI remained positive). In 2017, the q-statistics indicated that the explanatory power of GDP per capita to beds, health personnel, and health expenditure was 40.7%, 50.3%, and 42.5%, respectively. The coefficients of GWR remained positive with statistical significance, indicating the positive association between GDP per capita and health resources.ConclusionsFrom 2009 to 2018, the total amount of health resources in China has increased substantially. Spatial aggregation existed in the health-resources distribution. Health resources tended to be concentrated in wealthier areas. When allocating health resources, the governments should take economic factors into account.

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Ten years of progress--improved hysterectomy outcomes in Finland 1996-2006: a longitudinal observation study.

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Ten years of progress--improved hysterectomy outcomes in Finland 1996-2006: a longitudinal observation study.

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