LAUSR

STUDY OBJECTIVE To monitor and report nationwide changes in the rates of and complications after different methods for benign hysterectomy, operative hysteroscopy, myomectomy and embolization in Denmark. To report the national mortality after benign hysterectomy DESIGN: National prospective, observational cohort study SETTING: The Danish Hysterectomy and Hysteroscopy Database PATIENTS: Women undergoing surgery for benign gynecological diseases: 64,818 hysterectomies, 84,175 hysteroscopies, 4,016 myomectomies, and 1,209 embolizations in Denmark 2004 to 2018 INTERVENTIONS: National meetings with representatives from all departments, annual working reports of institutional complication rates, work shops, and national guideline initiative to improve minimally invasive surgical methods MEASUREMENTS: Rates of the different methods and complications after each method with follow up to five years as recorded by the database directly in the National Patient Registry MAIN RESULTS: Nationwide, a decline in use of hysterectomy, myomectomy, embolizations, and endometrial ablation. The total short-term complications were 9.8%, 7.5%, 8.9%, 2.7% respectively, however, with a persistent risk of approximately 20% recurrent operations within five years after endometrial ablation. Initially, we urged for increased use of vaginal hysterectomy, but only reached 36%. From 2010 we urged for reducing abdominal hysterectomies by implementing laparoscopic hysterectomy and reached 72% laparoscopic and robotic procedures. Since 2015 we used coring or contained morcellation for removal of large uterus at LH. The major and minor complication rates (modified Clavien-Dindo classification) were reduced significantly from 8.1 to 4.1% and 9.9 to 5.7% respectively. Mortality after benign hysterectomy was 0.27‰. The odds ratio for major complications after abdominal hysterectomy was 1.66 (1.52-1.81) compared to minimally invasive hysterectomy independent of length of stay, high-volume departments, indications, comorbidity, age and calendar year. CONCLUSION Fifteen years with a national database have resulted in a marked quality improvement: Denmark has 85% minimally invasive hysterectomies and has reduced the number of major complications by 50%.