Psychological Well-being After Hysterectomy
Psychological Well-being After Hysterectomy
Abstract & Commentary
by Frank W. Ling, MD, Clinical Professor, Dept. of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, is Associate Editor for OB/GYN Clinical Alert.
Dr. Ling reports no financial relationship to this field of study.
Synopsis: the general psychological well-being of patients after laparoscopic and abdominal hysterectomy is comparable 6 months after surgery.
Source: Persson P, et al. BJOG. 2006;113:1023-1030.
This is a prospective, randomized, multi-centered study from Sweden in which the psychological well-being of 125 women scheduled for hysterectomy was evaluated for up to 6 months post-operative. Of those enrolled, 119 completed the study with 56 undergoing abdominal hysterectomy and 63 having a laparoscopic hysterectomy. Assessments addressing general well-being, depression, and anxiety were performed preoperatively, at 5 weeks and 6 months. There was improved psychological well-being in both groups at 5 weeks compared to preoperative assessment. Laparoscopic hysterectomy was associated with a shorter hospital stay and shorter sick-leave, but a longer operating time.
Commentary
This is another piece of the puzzle in trying to determine the advantages and disadvantages of the various hysterectomy approaches that are available to us. The obvious strengths of this study include the number of patients, the prospective nature, and certainly the randomized study design. Even though the study was performed in Sweden rather than the United States, the findings should certainly be generalizeable.
Surgical procedures and postoperative care were standardized across institutions. Four different validated instruments were utilized to assess psychological well-being, anxiety, and depression. The findings were consistent with what we find in other studies, i.e., laparoscopic procedures take longer (64 vs 99 minutes), but result in shorter hospitalization (2 vs 3 days) and convalescence (26 vs 33 days). All other parameters such as complications, blood loss, and testing outcomes were not significantly different between the groups.
Even though something is statistically significant, is it necessarily clinically significant? For example, does the extra half an hour make a difference? In terms of cost, it certainly does add to the expense, but the patient is not necessarily aware, nor did the longer operating time result in more complications. Shorter hospitalization and briefer convalescence would certainly seem to logically be of clinical importance to the patient. Does this mean that laparoscopic hysterectomy is better than abdominal hysterectomy, especially in light of comparable psychological outcomes?
As with most studies like this, the answer is "it depends." It also has to be put in context of your individual practice. The study was conducted by skilled surgeons with the requisite laparoscopic and abdominal surgical abilities such that only 3 laparoscopic cases had to be converted to laparotomy.
The reassuring aspect is that the patients in the 2 groups had similar outcomes psychologically. There was no satisfaction survey done and that would certainly have helped us try to compare the 2 techniques better since our goal is deliver care in a fashion that satisfies the patients. Since all patients had to agree to randomization, we might expect that satisfaction was similar since the patients did not have a choice as to approach. That is where we must be extremely sensitive as to how we apply this to our respective practices. Often, patients will seek a specific surgical approach and it is paramount that we, as the surgeons, make sure that the surgical technique fits the clinical condition.
The sequence of decision-making should be:
- Is a hysterectomy necessary?
- Is the patient willing?
- What surgical approaches are within the skills of the surgeon?
- What are the expectations of the patient?
- How is the patient doing post-op?
By checking the expectations of the patients, then addressing these afterwards, we maximize the opportunity to achieve a successful outcome psychologically. As long as we choose the surgical approach on sound medical grounds, both the patient and the surgeon will do well.
This is a prospective, randomized, multi-centered study from Sweden in which the psychological well-being of 125 women scheduled for hysterectomy was evaluated for up to 6 months post-operative. Of those enrolled, 119 completed the study with 56 undergoing abdominal hysterectomy and 63 having a laparoscopic hysterectomy.Subscribe Now for Access
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