Our Summary

This study looked at the quality of care related to hysterectomy surgeries (removal of the uterus) in the U.S. Military Health System. It focused on several aspects, including the type of surgery (open vs. vaginal or laparoscopic), the length of hospital stay, and the amount of pain medication given at discharge. The study also looked at whether there were differences in treatment between Black and white patients.

The researchers analyzed medical records of over 11,000 women aged 18-65 who had a hysterectomy between 2017 and 2021. They looked at whether the surgery was done in a military or civilian hospital, and also took into account additional gynecological conditions and prescriptions.

They found that there was significant variation in the type of surgery performed and the amount of pain medication given at discharge. It was also found that Black patients were more likely to have an open surgery, stay in the hospital for more than a day, but received a similar amount of pain medication at discharge compared to white patients.

Patients treated in civilian hospitals, compared to military ones, were more likely to have a vaginal or laparoscopic surgery and given less pain medication at discharge, but also more likely to stay in hospital for more than a day.

The study suggests that better care for conditions like uterine fibroids, more access to vaginal and laparoscopic surgeries, and reducing variability in pain medication given at discharge could improve the quality and equality of care in the U.S. Military Health System.

FAQs

  1. What aspects of hysterectomy surgeries did the study focus on in the U.S. Military Health System?
  2. Were there any differences found in the treatment of Black and white patients undergoing hysterectomies?
  3. What improvements does the study suggest for the quality and equality of care in the U.S. Military Health System?

Doctor’s Tip

As a doctor, I would advise my patient undergoing a hysterectomy to discuss their options with their healthcare provider and ask about the different types of surgery available, such as vaginal or laparoscopic procedures, which may have shorter recovery times and less pain post-surgery. It’s also important to have a detailed conversation about pain management during and after the procedure to ensure optimal comfort and recovery. Additionally, it’s important to advocate for yourself and ensure that you are receiving the same level of care and treatment as all patients, regardless of race or background.

Suitable For

Patients who may be recommended for a hysterectomy include those with conditions such as uterine fibroids, endometriosis, abnormal uterine bleeding, pelvic organ prolapse, or gynecologic cancers. Hysterectomy may also be recommended for patients with chronic pelvic pain or other conditions that have not responded to other treatments. The type of surgery recommended will depend on the individual patient’s specific condition and medical history.

Timeline

Before hysterectomy:

  • Patient consults with a gynecologist to discuss symptoms and treatment options
  • Patient undergoes various tests and screenings to determine the need for surgery
  • Patient may receive counseling on the potential risks and benefits of hysterectomy
  • Patient schedules the surgery and prepares for the procedure

After hysterectomy:

  • Patient undergoes the surgery, which can be performed through open, vaginal, or laparoscopic methods
  • Patient stays in the hospital for a certain period of time depending on the type of surgery and recovery
  • Patient may experience pain and discomfort post-surgery, and is prescribed pain medication
  • Patient is discharged from the hospital and continues recovery at home, following post-operative care instructions
  • Patient may have follow-up appointments with the gynecologist to monitor healing and address any concerns.

What to Ask Your Doctor

Some questions a patient should ask their doctor about hysterectomy include:

  1. What are the different types of hysterectomy surgeries available and which one is most suitable for my condition?
  2. What are the potential risks and complications associated with the surgery?
  3. How long will I need to stay in the hospital after the surgery?
  4. What is the expected recovery time and when can I resume normal activities?
  5. Will I need to take pain medication after the surgery, and if so, how much and for how long?
  6. Are there any alternative treatments or procedures that I should consider before opting for a hysterectomy?
  7. Will I still be able to have children after the surgery?
  8. How will the surgery affect my hormone levels and menopausal symptoms?
  9. What follow-up care will be required after the surgery?
  10. Are there any specific considerations or differences in care that I should be aware of as a Black patient?

Reference

Authors: Johnson M, Carreño PK, Lutgendorf MA, Brown JE, Velosky AG, Highland KB. Journal: Eur J Obstet Gynecol Reprod Biol. 2023 Jul;286:52-60. doi: 10.1016/j.ejogrb.2023.05.006. Epub 2023 May 15. PMID: 37209523