Gynaecological Care The nine indicators in this set reflect three common gynaecological conditions and associated surgical procedures: hysterectomy, uterine prolapse surgery, and urinary incontinence surgery. Two of the indicators are based on data in the National Patient Register of the Swedish National Board of Health and Welfare. The first indicator concerns adverse events, complication that lead to rehospitalisation after hysterectomy, while the second indicator reflects resource utilisation and shows the percentage of uterine prolapse operations performed in day-case surgery. A third indicator looks at resource utilisation and shows cost per hysterectomy. The other six indicators concern patient-reported experience of the treatment they have received and are based on data from the National Quality Register for Gynaecological Surgery and the Gynaecology Quality Register. The various indicators reflect postoperative complications and unexpected problems, patient satisfaction, or the extent to which surgery provided symptomatic relief. Questionnaires were sent to patients both two months and one year after surgery. The National Quality Register for Gynaecological Surgery consists of six independent subregisters covering 90 per cent of the operations performed at 45 (of a possible 57) clinics around the country. Forty-three of the 45 clinics furnished data for regional comparisons. This year’s report also includes converted data from 11 clinics in Stockholm, Värmland and Gotland that participate in the Gynaecology Quality Register. Thus, total participation is high. The remarks about the individual indicators contain information about questionnaire response rate.
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Adverse Events after Hysterectomy
Hysterectomy is a fairly common procedure. As with all surgery, there is a risk of post-operative infection or other complications for which readmission may be required. The percentage of readmissions is a patient safety indicator for gynaecological care. Although individual hospitals cannot be held accountable for all readmissions, the indicator points to their responsibility to prevent infections, plan discharges properly and ensure that primary care is able to take over. The indicator shows adverse events, defined as readmission of hysterectomy cases unassociated with a cancer diagnosis. The most common reasons for such surgery are benign tumour of the uterus, uterine prolapse and profuse menstrual bleeding for which drug therapy is insufficient. Hysterectomy related to childbirth or injury is not included. According to the National Patient Register, almost 5 000 hysterectomies have been performed annually for benign indications in recent years. Partially due to new drug therapy options for profuse menstrual bleeding, the number of procedures has declined over the past ten years.
QUALITY AND EFFICIENCY IN SWEDISH HEALTH CARE 2012
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