Laparoscopic hysterectomy offers clear benefits to patients when compared to abdominal (open) hysterectomy, yet a large percentage of women continue to undergo the latter procedure. The purpose of this study is to explore the patient decision-making process in choosing the route of hysterectomy.
A questionnaire survey was mailed to all patients (N=3,878) who underwent hysterectomy at a suburban community hospital between 2011-2013. Questions addressed preoperative education, patient involvement, and patient satisfaction. Quantitative data was summarized in contingency tables and analyzed using Pearson chi-square; qualitative data was analyzed using content analysis.
The overall response rate was 10.3%. Nearly a third of respondents underwent open hysterectomy. Of those respondents, 48.2% indicated the route of hysterectomy “didn’t matter” to them and 13.7% “didn’t know about other surgical options,” compared to 14.8% and 8.5%, respectively of the laparoscopic group. Of the open group, nearly one third (31.7%) indicated their surgeon “did not talk about alternatives to open hysterectomy.” Compared to the laparoscopic group, open respondents were less likely to seek a second opinion, opting to have the surgery performed by their OB/GYN (44%), because “they trusted their OB/GYN” (76.6%). Only 1% of the open group performed on-line research regarding their surgical options. Of the open group, only 76% said they would recommend the same route of surgery, compared to 90.32% of the laparoscopic group.
The outcomes of this study point to a need for improved preoperative patient education and patient involvement in the surgical informed consent process.