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Hysterectomy. A critical review.

¹Department of Obstetrics and Gynecology, University of Medicine, and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick.

The Journal of Reproductive Medicine

|September 1, 1990

Summary

Hysterectomy has evolved into a safe procedure, but its use for quality-of-life improvements is complex. Societal factors and alternatives now influence surgical decisions beyond medical necessity.

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Area of Science:

Gynecology
Surgical Innovation
Medical Ethics

Background:

Hysterectomy, a surgical procedure involving the removal of the uterus, has a long history dating back to ancient times.
Historically, hysterectomy was associated with high morbidity and mortality rates.
Technological and medical advancements throughout the 20th century have significantly improved the safety of hysterectomy.

Observation:

The mortality rate for hysterectomy is now approximately 12 per 10,000 procedures.
While improved life quality and quantity are measurable for hysterectomies performed for life-threatening conditions like cancer, this is difficult to quantify for elective procedures.
Contemporary hysterectomy decisions involve multiple stakeholders, including physicians, patients, third-party payers, hospital administrators, and quality assurance programs.

Findings:

The safety of hysterectomy has dramatically increased due to medical and surgical advancements.
Assessing the benefits of hysterectomy for quality-of-life improvements presents challenges in objective measurement.
Non-medical factors, such as insurance, hospital policies, and regional practice standards, now influence surgical decision-making.

Implications:

Hysterectomy is now a relatively safe surgical option with a low mortality rate.
The decision-making process for hysterectomy is increasingly influenced by societal and economic factors, not just clinical indications.
The evaluation and utilization of alternatives to hysterectomy are becoming more prevalent, challenging its previous status as a primary treatment choice.

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