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The influence of psychological factors on recovery from hysterectomy

Hysterectomy is one of the most common gynaecological procedures performed in the non-pregnant woman.1 It can be performed through an incision in the abdomen, vagina or by a laparoscopic-assisted method. A Cochrane review of approaches to hysterectomy found a shorter hospital stay in women who have had a vaginal rather than a laparoscopic-assisted or abdominal hysterectomy,2 and the National Institute for Health and Clinical Excellence (NICE) has recommended a vaginal approach as first line.3 Regardless of this, in the real-life pragmatic situation, hospital statistics report that women who have undergone a vaginal hysterectomy, with no abdominal incisions, have an average postoperative stay of 3.2 days in England,4 which is longer than the laparoscopic approach and not much different to the stay after the abdominal route (Figure 1). This may indicate that in strictly controlled experimental designs clinicians are potentially achieving optimum care efficiency through their beliefs about therapy and through the inadvertent psychological preparation of all patients. This could be in the form of stringent consent procedures with increased access to support mechanisms and follow-up. It may be that patients' and healthcare professionals' beliefs and expectations of recovery play a more significant part in what actually occurs outside clinical trial settings. Aspects of this could be amenable to psychological intervention to improve recovery outcomes. 
 
 
 
Figure 1 
 
Incisions for hysterectomy and their associated recovery outcomes in clinical trials 
 
 
 
 
Psychological preparation 
Psychological preparation incorporates a range of strategies designed to influence how a person feels, thinks or acts (emotions, cognitions or behaviours). The benefits of psychological preparation for surgery have been evaluated in a meta-analysis.5 It identified many different types of psychological preparation, including procedural information, sensation information, behavioural instruction, hypnotic and relaxation training, psychotherapeutic interventions and cognitive behavioural approaches. They were found to be beneficial for a range of outcome variables such as negative affect, pain and pain medication, length of hospital stay, behavioural recovery, clinical recovery, physiological indices and satisfaction.