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Risikokommunikation bei operativen Eingriffen am Beispiel der Hysterektomie

Risk communication for operative interventions as exemplified by hysterectomy

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Der Gynäkologe Aims and scope

Zusammenfassung

Hintergrund

Ein zentrales Thema im Arzt-Patienten-Gespräch sind Risiken. Die verständliche Vermittlung von statistischen Daten, u. a. zu Häufigkeiten (un)erwünschter Ereignisse soll den Entscheidungsprozess für bzw. gegen eine Therapie und das Abwägen von alternativen Optionen ermöglichen.

Fragestellung

Herausgearbeitet und erläutert werden die Grundsätze einer guten Risikokommunikation bei operativen Eingriffen am Beispiel der Hysterektomie bei benigner Grunderkrankung.

Material und Methode

Literatursuche (MEDLINE, Cochrane Libary), Auswertung der aktuellen Publikationen und Leitlinien zur Risikokommunikation (AGO, ACOG, AWMF).

Ergebnisse

In 2007 wurden in Deutschland 142.385 Hysterektomien vorgenommen, davon 129.430 aufgrund benigner Erkrankung. Intraoperative Komplikationen treten unabhängig vom Verfahren bei 1,6 %, postoperative in 6 % der Fälle auf. Bezüglich der Komplikationsrate ist ein signifikanter Vorteil des laparoskopischen Vorgehens belegt, auch bei voroperierten Frauen. 12 % der Frauen unterziehen sich innerhalb von 32 Jahren nach Hysterektomie einer Zweitoperation aufgrund eines Genitalprolapses. Hinweise auf Störungen des psychischen Wohlbefindens oder des Sexualempfindens konnten nicht bestätigt werden. Alle Hysterektomieverfahren bei Blutungsstörungen und/oder symptomatischem Uterus myomatosus führen zu einer deutlichen Verbesserung der Lebensqualität.

Schlussfolgerungen

Gesamtüberblick und Interpretationshilfe der Datenfülle bieten Datenbanken und Leitlinien. Es bedarf statistischer Grundkenntnisse, um diese korrekt interpretieren und sich selbst vor „numerischen“ Manipulationen zu schützen. Trainingsprogramme können helfen die Risikobewertung zu verbessern und so die Kommunikation zu optimieren. Diese wiederum ist Grundvoraussetzung für einen Behandlungserfolg.

Abstract

Background

A central topic in physician-patient consultations deals with the communication of risks. The comprehensible communication of frequencies of desired and undesired events enables the patient to make a decision for or against a therapy and the weighing up of alternative treatment options. This requires the physician to give a clear communication of statistical data on the incidence and severity of side effects that must be weighed against the therapeutic goals and risk of failure.

Objectives

This article presents and explains the basic principles of successful risk communication for surgical interventions using the example of hysterectomy for benign diseases.

Methods

A literature search (Medline, Cochrane library) and an evaluation of current publications and guidelines on risk communication (published by the AGO, ACOG and AWMF) were carried out using the example of hysterectomy for benign diseases.

Results

A total of 142,385 hysterectomies were carried out in Germany in 2007 of which 129,430 were due to a benign disease. Intraoperative complications occurred in 1.6 % of cases independent of the procedure and postoperative complications occurred in 6 % of cases. Regarding complications a significant advantage of the laparoscopic approach is confirmed, even in women after previous surgery. Out of 154,882 women 12 % underwent a second operation because of pelvic organ prolapse within 32 years after hysterectomy. Evidence of disorders of psychological well-being or sexual feelings could not be confirmed. All hysterectomy procedures for bleeding disorders and/or symptomatic uterine fibroids led to a significant improvement in the quality of life.

Conclusion

Databases and guidelines provide an overview and an aid to interpretation based on the available data. Basic statistical knowledge is necessary for a correct interpretation and to avoid numerical manipulation. Training programs for doctors can help to improve the assessment of risks and thereby optimize the communication of the risks involved. This in turn is a prerequisite for successful treatment.

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Authors and Affiliations

  1. Department of Gynaecology and Obstetrics, University of Regensburg, Landshuter Str. 65, 93053, Regensburg, Deutschland

    S. Freifrau von Welser, O. Ortmann & S. Seitz

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  1. S. Freifrau von Welser
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Correspondence to S. Freifrau von Welser.

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S. Freifrau v. Welser, O. Ortmann und S. Seitz geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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O. Ortmann, Regensburg

W. Jonat, Kiel

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Freifrau von Welser, S., Ortmann, O. & Seitz, S. Risikokommunikation bei operativen Eingriffen am Beispiel der Hysterektomie. Gynäkologe 48, 586–592 (2015). https://doi.org/10.1007/s00129-015-3730-z

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