Adhesive bowel obstruction: Incidence, recurrence and 30-day mortality in Danish women 1984-2013 - A national cohort study.

BACKGROUND: Adhesive bowel obstruction is a serious complication to abdominal surgery. It is unknown whether incidence and mortality rates have changed as new surgical procedures were introduced. METHODS: In a nationwide cohort of Danish women from 1984 to 2013, incidence of adhesive bowel obstruction and 30 days mortality were presented as standardized rates. Impact of treatment was analyzed by Cox regression and recurrent disease characterized by Kaplan Meyer estimates. RESULTS: Incidence of adhesive bowel obstruction increased 50% among women with no prior abdominal surgery. These women had 3-5 times lower incidence than those with a surgical record. 30-day mortality rate was 13%, highest in patients treated non-operatively. The mortality declined in recent years. Recurrent disease had lower mortality rates compared to the first episode. CONCLUSIONS: The incidence of adhesive bowel obstruction increased during the last 30 years, mortality after the first episode is high, while recurrent disease shows declining mortality rates.

Complications after benign hysterectomy, according to procedure: a population-based prospective cohort study from the Danish hysterectomy database, 2004-2015.

OBJECTIVE: To compare the risk of complications associated with benign hysterectomy according to surgical procedure. DESIGN: Register-based prospective cohort study. SETTING: Danish Hysterectomy Database, 2004-2015. POPULATION: All Danish women with benign elective hysterectomy (n = 51 141). METHODS: Multivariate log-binomial regression to compute relative risks (RRs) stratified by calendar period, and adjusted for age, height, weight, smoking habits, use of alcohol, comorbidity, indications, uterine weight and adhesions. Multiple imputation and 'intention to treat' analyses were performed. MAIN OUTCOME MEASURES: Major (grades III-V) and minor (grades I-II) Clavien-Dindo modified complications within 30 days. RESULTS: Overall, major complications occurred in 3577 (7.0%) hysterectomies and minor complications occurred in 4788 (9.4%). The proportions of major and minor complications according to type of hysterectomy were: 10.3 and 9.6% for abdominal hysterectomy (AH); 4.1 and 12.1% for laparoscopic hysterectomy (LH); and 4.9 and 8.0% for vaginal hysterectomy (VH) for non-prolapse, and 2.3 and 6.4% for prolapse. In multivariate analyses, compared with VH for non-prolapse, the risk of major complications was higher for AH (RR 1.82, 95% CI 1.63-2.03) but lower for both LH (RR 0.78, 95% CI 0.68-0.90) and VH for prolapse (RR 0.55; 95% CI 0.41-0.75). For LH, the risk of major complications reduced from a RR of 0.96 (95% CI 0.75-1.22) in the time period 2004-2009 to an RR of 0.72 (95% CI 0.60-0.87) between 2010 and 2015. CONCLUSION: Laparoscopic hysterectomy and VH for uterine prolapse are associated with fewer major complications, and AH is associated with more major complications, compared with VH performed in the absence of uterine prolapse. TWEETABLE ABSTRACT: Laparoscopic hysterectomy has fewer major complications compared with vaginal hysterectomy, in the absence of uterine prolapse.

Hysterectomy on benign indication in Denmark 1988-1998. A register based trend analysis.

BACKGROUND: The aims of the study were to describe the trends in Danish hysterectomy rates from 1988 to 1998 for operations done on benign indication. METHODS: Data from all women (n=67,096) undergoing hysterectomy from 1988 to 1998 were obtained from the Danish National Patient Register. Data on the female population distribution were obtained from the Danish National Population Register. RESULTS: During the last 11 years the incidence rate of hysterectomy performed for benign diseases has been stable. However, the rate of women treated surgically for benign diseases of the uterus has increased by 14%. During the study period the number of total abdominal hysterectomies has decreased by 38%, the number of subtotal abdominal hysterectomies has increased by 458%, the number of vaginal hysterectomies has increased by 107% and two new methods of surgical treatment for benign diseases of the uterus have been introduced. Abdominal hysterectomy still accounts for 80% of the total number of hysterectomies performed in Denmark in 1998. The age distribution for all hysterectomies has changed, from a maximum of 36-45 years in 1988 to 46-55 years in 1998. The age maximum for abdominal hysterectomy corresponds to that of all hysterectomies. For vaginal hysterectomy the age maximum is 56 years or older, while it is 36-45 years for laparoscopic hysterectomy. CONCLUSIONS: The incidence rate of hysterectomy was stable during the study period and the age distribution for all hysterectomies has changed. The study showed a change in the choice of surgical methods, although no evidence supports this practice.

[Hypertension and hysterectomy in Danish women]. / Hypertension og hysterektomi hos danske kvinder.

The aim was to assess whether hypertension is a risk factor for hysterectomy. In a prevalence study, 2301 Danish women were selected at random in 1982. Information about cardiovascular diseases, hypertension, use of medicine, weight history, life-styles, psychological factors, gynaecological history, and social background were obtained. Blood pressure was measured. In an incidence study, the cohort was followed from 1982-1990 to assess the incidence of hysterectomy. In the prevalence study, hypertension partly explained the relation between hysterectomy and cardiovascular diseases. There were interactions between hypertension and previously found risk factors for hysterectomy. In the incidence study, hypertension was a risk factor in educated women (adjusted relative risk 2.88, 95% confidence interval 1.07-7.76) and in women with weight cycling (adjusted relative risk 3.31, 95% confidence interval 1.35-8.14). Hypertension might cause menorrhagia. These three risk factors contribute to women undergoing hysterectomy having an increased risk of cardiovascular diseases.

Hypertension and hysterectomy in Danish women.

OBJECTIVE: To assess whether hypertension is a risk factor for hysterectomy performed for benign diseases. METHODS: Self-report questionnaires were collected from 77% of 2301 Danish women aged 30, 40, 50, or 60 years selected at random in 1982 for a prevalence study. Information about cardiovascular diseases, hypertension, use of medicine, weight and dieting history, life-styles, psychologic factors, gynecologic history (including history of hysterectomy), and social background were recorded. Weight, height, and blood pressure were measured. In an incidence study, the cohort was followed during 1982-1990 via central registers to assess the incidence of hysterectomy. Logistic and Cox regressions were used to analyze data. RESULTS: In the prevalence study, history of hypertension partly explained the relation between hysterectomy and cardiovascular diseases. In the incidence study, history of hypertension and use of diuretics were significant risk factors for hysterectomy. After confounder control, use of diuretics was explained by weight-related variables, and hypertension was a risk factor for hysterectomy in educated women (adjusted relative risk [RR] 2.88, 95% confidence interval [CI] 1.07, 7.76) and in women with weight fluctuations (adjusted RR 3.31, 95% CI 1.35, 8.14). Weight cycling and lack of education remained significant risk factors for hysterectomy in women with and without hypertension, respectively. CONCLUSION: History of hypertension, weight cycling, and lack of education are closely related risk factors for premenopausal hysterectomy. These three risk factors contribute to women undergoing hysterectomy having an increased risk for cardiovascular diseases. We proposed that hypertension might be a plausible biological cause of menorrhagia and an indication for hysterectomy.

[Hysterectomy in a Danish population. Weight-related factors, psychological factors and life style variables]. / Hysterektomi i en dansk befolkning. Voegtrelaterede faktorer, psykologiske faktorer og livsstilsvariabler.

The aim was to assess risk factors for hysterectomy performed for benign conditions. In a prevalence study, 2301 Danish women were selected at random in 1982. Information about weight and slimming history, life-styles, psychological factors, gynaecological history, and social background were obtained. In an incidence study, the cohort was followed from 1982 to 1990 to assess the incidence of hysterectomy. In the prevalence study, weight cycling (recurrent weight loss and weight gain of more than 5 kg) was associated with hysterectomy for benign disease (adjusted odds ratio 1.77, 95% confidence interval 1.05-2.99) independently of overweight, smoking, oral contraceptives, psychological and social factors. In the incidence study, weight cycling was the only significant weight-related risk factor for hysterectomy performed for benign disease (adjusted relative risk 2.49, 95% confidence interval 1.10-5.60), explaining the relation between hysterectomy and psychological factors. Weight cycling might be an important risk factor for premenopausal hysterectomy performed for benign conditions.

Gynaecological correlates of hysterectomy in Danish women.

BACKGROUND: The aim has been to assess the gynaecological characteristics of importance for hysterectomy performed for benign diseases. METHODS: In a prevalence study, 2301 Danish women aged 30, 40, 50, or 60 years, were selected at random in 1982, and self-report questionnaires were collected from 77%. Information about gynaecological and obstetric history, social background, weight and dieting history, and various lifestyles were recorded. Weight and height were measured. In an incidence study, the cohort was followed during 1982-1990 via central registers to assess the incidence of hysterectomy. Logistic and Cox regression were used to analyse data. RESULTS: In the prevalence study, 85% of the hysterectomies were performed for benign conditions. Early menarche (< or = 11 years old) and short-term use of oral contraceptives (OC) (1-4 years) were independent correlates of these hysterectomies by multivariate analyses, whereas multiparity (> or = 4 childbirths) was confounded by education and weight-related factors. Long-term use of OC was associated with lower prevalence of hysterectomy. In the incidence study, short-term use of OC and ever use of progestogen-only minipills were independent risk factors for hysterectomy performed recently for benign diseases in women under 50 in the multivariate analyses. Abortions did not reach significance, and neither multiparity, long-term use of OC, nor early menarche were important. CONCLUSION: The most important gynaecological characteristics related to premenopausal hysterectomy performed for benign diseases are hormonal contraceptives. These findings imply that the decision-making process concerning hysterectomy might depend on women's choice of contraception and compliance with OC as medical treatment.

Hysterectomy in Danish women: weight-related factors, psychologic factors, and life-style variables.

OBJECTIVE: To assess weight-related risk factors, psychologic factors, and life-styles of importance for hysterectomy performed for benign conditions. METHODS: In a prevalence study, 2301 Danish women aged 30, 40, 50, or 60 years were selected at random in 1982, and self-report questionnaires were collected from 77%. Information about weight and dieting history, life-style, psychologic factors, gynecologic history, and social background were recorded. Weight, height, and plasma lipids were measured. In an incidence study, the cohort was followed during 1982-1990 via central registers to assess the incidence of hysterectomy. Logistic and Cox regression were used to analyze the data. RESULTS: In the prevalence study, weight cycling (recurrent weight loss and weight gain of more than 5 kg) was associated with hysterectomy for benign disease (odds ratio 1.77, 95% confidence interval [CI]1.05-2.99) by multivariate analysis independent of overweight, smoking, psychologic factors, social factors, and gynecologic characteristics. In the incidence study, all the weight-related factors except slimming diets were significant risk factors for hysterectomy performed recently for benign disease in women under age 50. In the multivariate analysis, weight cycling was the only significant weight-related factor (relative risk 2.49, 95% CI 1.10-5.60), explaining the relation between hysterectomy and psychologic factors. Coffee, tea, alcohol, smoking, and plasma lipids were not related to hysterectomy in either study. CONCLUSION: Weight cycling might be an important risk factor for premenopausal hysterectomy performed for benign conditions. Whether weight cycling causes menstrual irregularities and leiomyomas, these results give us a better understanding of the pathways to hysterectomy.

Hysterectomy in a Danish cohort. Prevalence, incidence and socio-demographic characteristics.

BACKGROUND: The aim has been to assess the frequency of hysterectomy in relation to sociodemographic characteristics. MATERIALS AND METHODS: A cross-sectional survey of 2,403 women selected at random from the population in the western part of Copenhagen County. One thousand seven hundred and sixty-five Danish women (77%) filled in the questionnaire and took part in the interview. The cohort was followed for eight years through central registers to assess the incidence of hysterectomy. Logistic and Cox regression were used as main statistics. RESULTS: Life time prevalence of hysterectomy was 10.4%. In the prevalence study, hysterectomy on benign diagnoses (85%) was related to short schooling, lack of vocational education, and low social status personally as well as regards the family. In the multivariate analyses school education, vocational education, and ascending social status by marriage were independent explanatory variables. In the incidence study, the crude rate of hysterectomy on benign diagnoses was 3.4 pr. 1000 years, with the 40-year-old women having the highest rate (7.8 pr. 1000 years). Risk factors as regards hysterectomy due to bleeding disorders and uterine fibroids at ages <50 (premenopausal) were unemployment and lack of vocational education, only the latter reached significant level in the multivariate analysis. CONCLUSION: There are social inequalities regarding premenopausal hysterectomy on benign diagnoses, but the social-demographic indicators of interest have changed through the last decades. Short schooling and lack of social mobility by marriage were only associated with the hysterectomies performed before 1982, whereas lack of vocational education was related to hysterectomy independent of the calendar period involved. A woman without education has a relative risk of 2.2 (1.1-4.4) for hysterectomy compared to an educated woman.

[Vaginitis emphysematosa]. / Vaginitis emphysematosa.

Vaginitis emphysematosa is a benign, uncommon condition characterised by the presence of gas-filled cysts beneath the vaginal epithelium. Cases has been reported in pregnant women, in patients with diseases of the cardiovascular system and in patients with Trichomonas or Gardnerella vaginitis. To date the etiology and pathogenesis have not been fully elucidated. A case of vaginitis emphysematosa in a patient with cardiovascular disease is described.