Our Summary

This research paper studied the number of hysterectomies (a surgery to remove a woman’s uterus) performed by recent medical school graduates compared to more experienced doctors in Massachusetts from 2005 to 2014. They found that new doctors performed this surgery less frequently than the more experienced doctors.

The study found that recent graduates were more likely to perform the surgery by making a cut in the abdomen, rather than doing it vaginally, which is the recommended method. On average, new doctors performed 3-4 hysterectomies a year after their graduation, and this number didn’t increase over time. They rarely did the surgery vaginally or using a laparoscope (a small tube with a light and a camera that’s inserted through a small incision).

In comparison, experienced doctors did 8-9 hysterectomies a year and were more likely to do them vaginally. However, the researchers found that this difference could be explained by the characteristics of the patients the doctors were treating, rather than the doctors’ preferences or skills.

FAQs

  1. Do recent medical school graduates perform hysterectomies less frequently than more experienced doctors?
  2. Are new doctors more likely to perform hysterectomies by making a cut in the abdomen rather than doing it vaginally?
  3. What explains the difference in the number and type of hysterectomies performed by recent graduates and experienced doctors, according to the research?

Doctor’s Tip

A helpful tip a doctor might give a patient about hysterectomy is to discuss with their doctor the different surgical options available, including vaginal and laparoscopic approaches, as these may have shorter recovery times and fewer complications compared to an abdominal approach. It is important for patients to be informed about the different options and to have a thorough discussion with their doctor to determine the best approach for their individual situation.

Suitable For

Patients who are typically recommended for a hysterectomy include those with:

  1. Severe, persistent pelvic pain: Chronic pelvic pain that does not respond to other treatments such as medication or physical therapy may warrant a hysterectomy.

  2. Uterine fibroids: Large fibroids that cause symptoms such as heavy menstrual bleeding, pelvic pain, or pressure on the bladder or bowel may require a hysterectomy.

  3. Endometriosis: Severe endometriosis that does not respond to other treatments may be treated with a hysterectomy.

  4. Uterine prolapse: When the uterus drops into the vaginal canal due to weakened pelvic floor muscles, a hysterectomy may be necessary to correct the condition.

  5. Gynecologic cancer: Hysterectomy is often recommended as part of the treatment for gynecologic cancers such as uterine, cervical, or ovarian cancer.

  6. Abnormal uterine bleeding: Persistent, heavy, or irregular bleeding that does not respond to other treatments may be a reason for a hysterectomy.

  7. Adenomyosis: A condition where the tissue that lines the uterus grows into the muscular wall of the uterus, causing pain and heavy menstrual bleeding.

It is important for patients to discuss all treatment options with their healthcare provider to determine the best course of action for their individual situation.

Timeline

Before the hysterectomy:

  1. Patient experiences symptoms such as pelvic pain, abnormal bleeding, or other gynecological issues that lead to the decision to undergo a hysterectomy.
  2. Patient consults with their gynecologist or healthcare provider to discuss the need for a hysterectomy and explore other treatment options.
  3. Patient undergoes pre-operative testing and evaluation to assess their overall health and determine the best approach for the surgery.
  4. Patient may receive counseling or support to prepare for the emotional and physical impact of the surgery.

After the hysterectomy:

  1. Patient undergoes the surgery, either through an abdominal incision, vaginal approach, or laparoscopic procedure.
  2. Patient stays in the hospital for a few days to recover from the surgery and manage any post-operative pain.
  3. Patient may experience side effects such as fatigue, vaginal bleeding, or changes in hormone levels as they recover from the surgery.
  4. Patient follows up with their healthcare provider for post-operative care and monitoring to ensure a smooth recovery.
  5. Patient may experience improvements in their symptoms and quality of life after the hysterectomy, such as relief from pelvic pain or heavy menstrual bleeding.

What to Ask Your Doctor

  1. What are the different types of hysterectomy procedures available, and which one would be most suitable for my specific condition?
  2. What are the potential risks and complications associated with a hysterectomy?
  3. What are the expected outcomes and recovery time after the surgery?
  4. Are there any alternative treatments or therapies that I should consider before opting for a hysterectomy?
  5. Will a hysterectomy affect my hormonal balance or menopausal symptoms?
  6. How will a hysterectomy impact my fertility and sexual function?
  7. How experienced are you in performing hysterectomies, and what is your success rate with this procedure?
  8. Are there any specific pre-operative or post-operative instructions that I should follow to optimize the outcome of the surgery?
  9. What long-term effects should I be aware of after undergoing a hysterectomy?
  10. Are there any lifestyle changes or precautions that I should take post-surgery to ensure a smooth recovery process?

Reference

Authors: Cadish LA, Kropat G, Muffly TM. Journal: Female Pelvic Med Reconstr Surg. 2021 Jun 1;27(6):382-387. doi: 10.1097/SPV.0000000000000879. PMID: 32371719