Risk communication for operative interventions as exemplified by hysterectomy [Risikokommunikation bei operativen Eingriffen am Beispiel der Hysterektomie]

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. © 2015, Springer-Verlag Berlin Heidelberg.