Guest Author - Dr. Denise Howard
Hysterectomy, one of the most commonly performed surgical procedures in women, can be performed safely with minimum disruption to a woman’s life. Nothing in life is risk free and with surgery there is always a risk of an adverse outcome or surgical complication. The general and specific risks of this procedure will be reviewed in this article.
By the time you are signing a surgical consent, you should have a full understanding of what will be done, why it is being done and the potential risks and complications. Your signature on the consent is your confirmation of this understanding and permission to the providers to perform the surgery. The informed consent process is a part of best practices and is legally required in most countries.
Prior to signing the consent you should have a full understanding of the procedure specific risks. The risks include injury to adjacent organs, bleeding requiring a blood transfusion, risk of infections and the possible need for additional surgery. The risks are dependent on the route of the surgery, the length of the surgery, the health of the individual and the presence of intraabdominal pathology that may cause surgical difficulties. The risks of a hysterectomy are lower when performed through the birth canal and higher when performed laparoscopically. The longer the surgery the greater the risks, especially those related to infection. The length of the surgery could also reflect the complexity of the procedure, which also increases the risks. Finally younger, healthier and normal weight individuals have a lower risk of surgical complications.
The risks of unintended major surgical complications are around 0.5%. The more serious complications of hemorrhage occur at a rate of 2% while bladder and bowel injury occur 1% of the time. One of the more concerning injuries is that to the ureter, which is injured more with a hysterectomy than any other surgical procedure. This is due to its close proximity to the uterus. This occurs less than 1% of the time.
Infections can occur at a variety of sites. A deep intrabdominal infection, which might involve an abscess and need for additional surgery occurs at a rate of 0.1% while a wound infection of the skin or abdominal wall is reported 3% of the time. Urinary tract infections are reported at a rate of 4%. Pneumonia is another infection that can occur have major surgery. Most of these infections are easily managed when identified early.
Other risks that can occur as a result of any major surgery include myocardial infarction, stroke and pulmonary embolus (PE). PE requires special attention in the gynecologic population, as it is the most common cause of death in young women who undergo pelvic surgery. It tends to occur when a clot from a deep venous thrombosis in the lower extremities, travels to the lungs. The rate of venous thromboembolism after a major gynecologic surgery is 15-30% if no prophylaxis is used. The risk of death from a hysterectomy is less than 0.5/1000 procedures and tends to result from either a cardiac event or a pulmonary embolus.
Some complications are identified immediately and when managed promptly have minimal long-term consequences. Some complications may not be immediately obvious and develop over a few days to a week or so after the procedure. This highlights the importance of understanding the postoperative instructions and seeking care promptly if there is a concern as described in most postoperative instructions. The 6-week point is usually the time when a full recover can be presumed. If complications occur it is usually within this period. The notable exception is a bowel obstruction due to adhesions, which can develop immediately or months to years after a surgery.
The vast majority of hysterectomies are uncomplicated. Even when complications occur they are usually managed with minimal long-term problems. Standard pre-surgical preparations are designed to minimize many of the more serious complications. Perioperative antibiotics provide a 10-fold reduction in the risk of infections while venous thromboembolism prophylaxis reduces the risk of deep venous thrombosis from a high of 30% to a low of 0.2%. Good surgical technique, early mobilization, removal of catheters as early as possible and thorough pre-surgical planning also aide tremendously in minimizing surgical complications.
If you are planning to have a hysterectomy then do your homework and make sure the communication between you and your surgeon is clear. Understand the reasons for the surgery, exactly what will be done and how, and the potential risks. Ask what will be done to minimize the risks of these complications and be clear on the postsurgical instructions. If you have medical problems then seek the advice of your Internists or the appropriate specialist to maximize your health prior to surgery. If you have heart problems then see your Cardiologist. If you have diabetes, work with your doctor to get your glucose levels under control. You are a vital member of your healthcare team and it is in your best interest to work your doctors to increase your chances of having a successful outcome.
I hope this article has provided you with information that will help you make wise choices, so you may:
Live healthy, live well and live long!