Surgery & Women’s Health: Just OK is not OK

“Guess who just got reinstated?!” a doctor proclaims down the hall to an off-screen colleague.

It’s a memorable line from a widely-aired AT&T commercial with a surgery theme. After a humorous but unsettling conversation between the physician and patient, the second memorable line from the commercial appears on screen:

“Just OK is not OK.”

That’s the case generally in healthcare, and it’s certainly the case in women’s health, where, unfortunately, OK is being accepted all too often today.

Hysterectomy– a surgical procedure to remove a woman’s uterus—dates back to ancient times. In fact, vaginal hysterectomies are believed to have originated nearly 2,000 years ago. The first abdominal hysterectomy occurred in England in 1843.

Hysterectomy is the most common non-pregnancy-related major surgery performed on American women. Surprisingly, surgical techniques haven’t changed as much as you might think over the centuries.

In a recent Goldfinch Health analysis of a large employee population, nearly 30% of hysterectomies were performed just as they would have been hundreds of years ago, through an open surgical procedure. This despite 30 years of evidence supporting the benefits of laparoscopic, and now robotic-assisted, procedures being available to and appropriate for most patients!

Surgery quality is not only a healthcare cost/waste issue. It’s a women’s health issue.  Specifically, delivery of 21st Century surgery guided by minimally-invasive techniques and Advanced Surgical Pathways is an option about which women should be aware should a time arise when they face surgery.

What is the result of women being unnecessarily subjected to outdated hysterectomies?

  • Longer hospital stays
  • Greater risk of complications, like infections and need for follow-up surgery
  • Greater exposure to opioid painkillers
  • And longer recoveries

Unfortunately, hysterectomy isn’t the only area where too many women are receiving sub-standard surgical care in today’s healthcare system. Evidence supports revolutionary approaches (and results) for breast surgery and cesarean birth as well:

  • Women undergoing a mastectomy to remove one or both breasts (often related to cancer) may be able to greatly reduce their need for opioids and improve their post-operative pain scores by finding a procedure delivered as part of an Advanced Surgical Pathway (known as Enhanced Recovery After Surgery, or ERAS, in the medical field).
  • Women experiencing cesarean birth guided by Advanced Surgical Pathways have been shown to experience shorter overall postoperative length of stay, improved satisfaction and an increase in breastfeeding rates. In addition, Advanced Pathways in this area have shown promise in improving maternal pain control with fewer opioids.

Yet, just like with hysterectomies, these updated procedures remain sporadically-adopted by healthcare providers and very challenging to find for an individual patient without a professional careguide.

The factors underlying the state of hysterectomies in the U.S. are complex and illustrative of the larger issue in surgery. Many women choose to stay with the physician they trusted years earlier with the delivery of their children. When/if a hysterectomy becomes necessary, they understandably opt for the obstetrician (OB) they know rather than the gynecologist (GYN) they do not know, despite the GYN having specific training and experience with this procedure. A comfort level with the relationship, and perhaps even a sense of loyalty, keep women from seeking out a GYN best-suited for their particular procedure. This is how women find themselves accepting a suboptimal procedure and the associated risks.

More generally, these advanced practices have yet to be more widely adopted because:

  • Patients aren’t informed enough to demand them
  • Healthcare change is difficult (studies have shown change in healthcare takes 17 years from research to practice implementation)

Something better is possible for most women facing surgery. It’s often just a few questions away.

At Goldfinch Health, we are driven to take the “just OK” out of surgery, and we are here to help you determine how that is possible for you.