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1. Preparation

WHAT IS A HYSTERECTOMY?

Hysterectomy means removal of the uterus, or womb, and is one of the most common types of elective operations performed on Australian women. There are several different types of hysterectomies, performed for different reasons and resulting in different outcomes.

The most common types of hysterectomy are:

  • Radical hysterectomy - the removal of the uterus, fallopian tubes, tissues on both sides of the cervix (parametrium), ovaries and the upper part of the vagina and the attached pelvic ligaments and lymph nodes.

  • Hysterectomy with bilateral salpingo-oophorectomy - the removal of the uterus, fallopian tubes and ovaries.

  • Total hysterectomy - the removal of the entire uterus and the cervix; the ovaries remain.

Sometimes the type of hysterectomy you need will be clear-cut based on your diagnosis, eg. if you have cancer a radical hysterectomy may be your only option. However, in many instances you may be offered some choice, particularly in relation to whether or not your ovaries should be removed. In a pre-menopausal woman, removing her ovaries will cause an instantaneous (or surgical) menopause, which some women may find a difficult or unwanted side effect. However, some gynaecologists will recommend this option because it eliminates the chance of developing ovarian cancer in the future.


You need to have a clear understanding of advantages and disadvantages of taking this option because it obviously has major implications in your life. Remember that for the majority of women (except those who have cancer or an emergency hysterectomy after childbirth), a hysterectomy is rarely urgent and therefore you should take your time deciding on a course of action.

In terms of the procedure itself, there are three ways a hysterectomy can be performed:


  • Abdominal Hysterectomy (through an incision in the lower abdomen)
  • Vaginal hysterectomy
  • Laparoscopic Hysterectomy (“keyhole surgery” through small incisions in the abdomen)

The route chosen will depend on a variety of factors including the reason for the operation, the extent of surgery required, a woman’s anatomy including weight and previous pelvic surgery etc, and the surgeon’s expertise and choice.


hysterectomy-02.gif

WHY IS IT DONE?

Common indications include:


  • Fibroids (benign tumours also referred to as myomas)
  • Cancer of the cervix, uterus, ovaries or fallopian tubes
  • Menstrual related problems such as very heavy bleeding or excessive pain
  • Endometriosis (uterine glands that grow in other pelvic tissues)
  • Pelvic inflammatory disease (chronic infection)
  • Uterine prolapse (uterus pushing into the vagina)

Of these, the most common cause amongst Australian women is fibroids. There are an increasing number of medical or less invasive surgical options to treat fibroids, as there are for many of the other conditions. This does not mean that a hysterectomy isn’t an appropriate (indeed sometimes the only) option; only that, as indicated previously, the need for a hysterectomy is rarely urgent and as such you should be satisfied that you have fully explored all your options. Your gynaecologist should be able to discuss all the available treatments with you, as well as giving you expert advice on what is appropriate for your individual circumstance.

HOW DO I CHOOSE A SPECIALIST?

Your GP, or the doctor you first consult, will be able to recommend and refer you to a Gynaecologist who can perform the procedure.

You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. You can access the Royal Australasian College of Surgeons via their website www.surgeons.org. This is a very informative website.

The list of questions below may help you to better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) does a particular doctor operate from, and what are their fees. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website.

To access a list of Gynaecologists who participate in HCF’s Medicover no gap arrangement:

Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover No Gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment.

WHAT SHOULD I ASK MY SPECIALIST?

  • Do not be afraid to ask your doctor questions about the procedure and any side effects which can occur. It is your right to know all the relevant information, as this is part of informed clinical and financial consent. Your doctor will ask you to sign a consent form.
      • Are there any other treatments that I should consider before having a hysterectomy?
      • What type of hysterectomy is best for me and why?
      • What route will you take – abdominal/vaginal/laparoscopic and why?
      • (If pre-menopausal) will the surgery induce the menopause. Should I take HRT?
      • Are there likely to be other lifestyle implications, such as an effect on sexual function?
  • In addition to what the procedure involves, you should also ask about:
    • Preparation
    • Follow up appointments, jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
    • Aftercare
  • Most medication should be continued as usual, but some may interfere with the operation. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:
  • Aspirin (or any related products)
  • Blood thinners (Warfarin, heparin.)
  • Arthritis medication
  • Pain medication
  • Anti-inflammatory medication
  • Insulin

Don’t forget to mention any homeopathic or herbal remedies you are taking, as these can have interactions and side effects too.

WHERE IS IT DONE?

A hysterectomy is done in an overnight hospital. Your expected length of stay will be about 2-3 days after vaginal hysterectomy and 5-6 days after abdominal surgery.

HOW LONG IS THE PROCEDURE?

The procedure time varies considerably, but may take between 1-3 hours depending on individual circumstance.

WHO IS INVOLVED?

The people involved in the procedure are:

  • The Gynaecologist, your Specialist doctor
  • There may be an assistant surgeon
  • Anaesthetist : they give you medication that makes you relaxed and sleepy and look after you whilst the procedure is being carried out
  • Nurses for the procedure and recovery
  • Radiologist if any x-rays are necessary
  • Pathologist for blood tests and/or specimen samples

HOW DO I PREPARE FOR A HYSTERECTOMY?

Because the hysterectomy will be done under a general anaesthetic, you may need to undergo some basic tests to ensure your overall health is suitable for the procedure. This will depend on your age and health, and could include such things as an ECG (recording of your heart rhythm), chest x-ray and blood tests.

If you are a smoker and you cannot give up completely, try to reduce smoking in the weeks leading up to your surgery; this may help to lower the risk of post-operative complications such as chest infection.

You will be given medication to use as directed to clear your bowel before the operation and advised not to eat or drink for at least 6 hours before the surgery.


Please follow any instructions given to you by the Hospital. Your doctor will have his/her own specific preparation requirements as well. These instructions should be strictly followed.

WHAT DO I TAKE WITH ME TO THE HOSPITAL?

  • Do not bring any valuables with you
  • Leave all jewellery at home, a wedding ring is acceptable
  • Wear comfortable clothing
  • Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
  • Bring any relevant x-rays or scans

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

ABDOMINAL HYSTERECTOMY

For your information, the average charges for claims paid for Abdominal Hysterectomy admissions for the financial year 13/14 are provided below:

On Average

Charge Medicare Pays HCF Pays 3 If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement 4 If your doctor USES HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor USES HCF’s No Gap Arrangement
Total Average Hospital Component (accommodation, theatre and hospital related services) $6,145 $0 $5,884
1 Medical Services Component
Anaesthetic Services $866 $303 $274 $631 45.8% $0 54.2%
Assistant in Operations Services $277 $121 $84 $255 27.9% $0 72.1%
Gynaecological Surgical Services $1,469 $588 $462 $1,250 33.5% $0 66.5%
Pathology Services $300 $148 $142 $151 6.4% $0 93.6%
Specialist Consultation $203 $112 $72 $122 15.0% $0 85.0%
2 Total Average Medical Services $2,714 $1,088 $902 $1,324 54.6% $0 45.4%
Hospital and Medical Services Average for Abdominal Hysterectomy Admissions $8,859 $1,088 $6,786 $1,324 54.6% $0 5 45.4%

hysterectomy abdominal_14.gif

Points to Note:

  • Charges are based on HCF claims for a sample size of 538 overnight admissions with an average length of stay of 4.3 days in private participating hospitals (private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare items 35653 and 35661.
  • As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).

1 These medical services are in-patient services only.

2 The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here. Therefore, the total average medical service charge ($2,714) differs from the sum of the individual average charges as shown.

3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.

4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.

5 This percentage indicates the total coverage of hospital and medical services for all abdominal hysterectomies. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.

VAGINAL HYSTERECTOMY

For your information, the average charges for claims paid for Vaginal Hysterectomy admissions for the financial year 13/14 are provided below:

On Average

Charge Medicare Pays HCF Pays 3 If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement 4 If your doctor USES HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor USES HCF’s No Gap Arrangement
Total Average Hospital Component (accommodation, theatre and hospital related services) $5,638 $0 $5,369
1 Medical Services Component
Anaesthetic Services $685 $251 $256 $520 34.2% $0 65.8%
Assistant in Operations Services $272 $131 $97 $284 15.0% $0 85.0%
Gynaecological Surgical Services $1,524 $663 $598 $1,421 18.6% $0 81.4%
Pathology Services $238 $112 $119 $137 2.9% $0 97.1%
Specialist Consultation $191 $109 $73 $57 13.3% $0 86.7%
2 Total Average Medical Services $2,594 $1,106 $1,022 $1,159 39.8% $0 60.2%
Hospital and Medical Services Average for Vaginal Hysterectomy Admissions $8,232 $1,106 $6,391 $1,159 39.8% $0 5 60.2%

hysterectomy vaginal_14.gif

Points to Note:

  • Charges are based on HCF claims for a sample size of 247 overnight admissions with an average length of stay of 3.2 days in private participating hospitals (private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 35657.

  • As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).

1 These medical services are in-patient services only.

2 The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here. Therefore, the total average medical service charge ($2,594) differs from the sum of the individual average charges as shown.

3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.

4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.

5 This percentage indicates the total coverage of hospital and medical services for all vaginal hysterectomies. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.

2. Day of procedure

WHAT HAPPENS TO ME AT THE HOSPITAL?

When you arrive at the hospital, the admissions clerk will attend to the paperwork associated with your stay.

On admission to the hospital a nurse will orientate you to your surroundings and request your medical history, current medication and any known allergies. The consent for the operation is attended to by the surgeon. An anaesthetist will visit you prior to your operation to discuss your anaesthetic. A general anaesthetic is given which means that you are asleep throughout the procedure. You will also discuss the type of pain relief you will receive after the operation.


Sometime before theatre, you may be asked to shower with an antiseptic wash. If you are having an abdominal hysterectomy your pubic hair will need to be shaved, although this is sometimes done in theatre.

An intravenous line will be put into the back of your hand so that you can be given sedation, antibiotics and fluid replacement.

WHAT CAN I EXPECT DURING A HYSTERECTOMY?

When you arrive in the operating theatre, you will be taken into the anaesthetic bay. If not already inserted, you will have a cannula (a small plastic tube) inserted into a vein in your arm or hand. The anaesthetist will use this to inject some sedation, the first part of your general anaesthetic, after which you won’t remember anything until you wake up in recovery.

Your surgeon may use one of three techniques detailed below to perform either a partial, total or radical hysterectomy.

ABDOMINAL HYSTERECTOMY:

An abdominal hysterectomy is generally preferred when the procedure is being performed in the presence of cancer to allow for extensive exploration. It may also be required when large fibroids, multiple adhesions or endometriosis are present.

An incision of about 8-10cm is usually made across the pubic hairline, which for most women, will result in a small scar and less time for recovery than an incision down the middle of the abdomen. The uterus, and if appropriate ovaries and other organs, are removed and the area is closed with sutures or staples.

VAGINAL HYSTERECTOMY:

Removal of the uterus by this method is used when the uterus is small or a uterine prolapse is evident (where weakened pelvic floor muscles, ligaments or vaginal walls allow the uterus to move from its position in the pelvic cavity, into the vagina).

A vaginal hysterectomy is performed solely through the vagina. In the upper part of the vagina an incision is made and the uterus is removed through the vagina. This method is advantageous in that there is less pain, the hospital stay and recovery time is shorter and there is no physical scar.

LAPAROSCOPIC HYSTERECTOMY:

Laparoscopic (or “keyhole”) surgery involves making 3 or 4 small incisions in the abdomen. A laparoscope is placed through one of the incisions into the abdomen to enable the surgeon to see the pelvic organs on a video screen. The other incisions are used to allow the introduction of instruments necessary to remove the uterus through one of the incisions. The operating time may be slightly longer than an open repair but, if the surgeon is suitably skilled in the procedure, the recovery is traditionally shorter.

3. Aftercare

WHAT HAPPENS AFTER A HYSTERECTOMY?

Following the surgery, you will be taken to recovery where you will be closely monitored by nursing staff. Your vital signs will be checked on a continual basis until you are fully conscious, when you will be returned to the ward.

When you wake you will be receiving supplemental oxygen via a mask over your nose and mouth, or small plastic tubes in your nostrils. You will usually have a drip attached to the cannula in your hand or arm, which will be used to give you fluids until you are drinking normally. You will also have a catheter in your bladder so urine is drained continuously into a bag. Nursing staff will closely monitor the amount of blood you are losing vaginally.

Once back on the ward you will be helped to get out of bed and start moving as soon as you are able, in order to reduce the many complications of bed rest. You may be able to shower late on the same day if you have had a vaginal hysterectomy, but getting mobile will be more delayed following an abdominal procedure. Similarly, you will be able to start drinking fluids and build up a normal diet almost immediately following a vaginal procedure but will have to wait a day or so after an abdominal hysterectomy. This is because of increased handling, and subsequent lack of motility, of the bowel following an abdominal operation. To avoid blood clots in your legs, firm stockings are usually worn.

Your pain relief will depend on your operation and individual pain tolerance. You will commonly receive strong tablets and an injection if required. After an abdominal hysterectomy you may be given a machine called a PCA, patient controlled analgesia, which allows you to press a button and deliver small doses of a drug such as morphine into a drip in your vein. The machine is carefully programmed so that you cannot give yourself too much analgesia. After a laparoscopic hysterectomy many people experience pain in the shoulder tips, which is referred pain due to air trapped under the diaphragm.

It is important to do the pelvic floor and abdominal exercises from about the second day after your surgery, as per your doctor’s instructions prior to your surgery. Your surgeon will make an appointment to see you 6 weeks after the surgery.

Upon discharge you should be given specific advice about any self care necessary in the intervening weeks. You should be clear on the following issues:

  • Wound care
  • Level of activity, particularly heavy lifting
  • Returning to work
  • Driving (don’t forget to also check with your car insurance company in case they have any restrictions following an operation)
  • What to expect in terms of vaginal discharge
  • Pain relief, and any changes to your regular medication

You should also be advised of who to contact if you experience any problems or have any concerns. As a guide, you should seek medical assistance if you experience any of the following:

  • Swelling or redness around the incision
  • Seepage or bloody discharge from the wound
  • Fever and chills
  • Swollen abdomen
  • Pain that is not relieved by prescribed pain medication

1. Preparation

WHAT IS A HYSTERECTOMY?

Hysterectomy means removal of the uterus, or womb, and is one of the most common types of elective operations performed on Australian women. There are several different types of Hysterectomy, performed for different reasons and resulting in different outcomes.

The most common types of hysterectomy are:

  • Radical hysterectomy - the removal of the uterus, fallopian tubes, tissues on both sides of the cervix (parametrium), ovaries and the upper part of the vagina and the attached pelvic ligaments and lymph nodes.

  • Hysterectomy with bilateral salpingo-oophorectomy - the removal of the uterus, fallopian tubes and ovaries.

  • Total hysterectomy - the removal of the entire uterus and the cervix; the ovaries remain.

Sometimes the type of hysterectomy you need will be clear-cut based on your diagnosis, eg. if you have cancer a radical hysterectomy may be your only option. However, in many instances you may be offered some choice, particularly in relation to whether or not your ovaries should be removed. In a pre-menopausal woman, removing her ovaries will cause an instantaneous (or surgical) menopause, which some women may find a difficult or unwanted side effect. However, some gynaecologists will recommend this option because it eliminates the chance of developing ovarian cancer in the future.


You need to have a clear understanding of advantages and disadvantages of taking this option because it obviously has major implications in your life. Remember that for the majority of women (except those who have cancer or an emergency hysterectomy after childbirth), a hysterectomy is rarely urgent and therefore you should take your time deciding on a course of action.

In terms of the procedure itself, there are three ways a hysterectomy can be performed:


  • Abdominal Hysterectomy (through an incision in the lower abdomen)
  • Vaginal hysterectomy
  • Laparoscopic Hysterectomy (“keyhole surgery” through small incisions in the abdomen)

The route chosen will depend on a variety of factors including the reason for the operation, the extent of surgery required, a woman’s anatomy including weight and previous pelvic surgery etc, and the surgeon’s expertise and choice.


hysterectomy-02.gif

WHY IS IT DONE?

Common indications include:


  • Fibroids (benign tumours also referred to as myomas)
  • Cancer of the cervix, uterus, ovaries or fallopian tubes
  • Menstrual related problems such as very heavy bleeding or excessive pain
  • Endometriosis (uterine glands that grow in other pelvic tissues)
  • Pelvic inflammatory disease (chronic infection)
  • Uterine prolapse (uterus pushing into the vagina)

Of these, the most common cause amongst Australian women is fibroids. There are an increasing number of medical or less invasive surgical options to treat fibroids, as there are for many of the other conditions. This does not mean that a hysterectomy isn’t an appropriate (indeed sometimes the only) option; only that, as indicated previously, the need for a hysterectomy is rarely urgent and as such you should be satisfied that you have fully explored all your options. Your gynaecologist should be able to discuss all the available treatments with you, as well as giving you expert advice on what is appropriate for your individual circumstance.

HOW DO I CHOOSE A SPECIALIST?

Your GP, or the doctor you first consult, will be able to recommend and refer you to a Gynaecologist who can perform the procedure.

You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. You can access the Royal Australasian College of Surgeons via their website www.surgeons.org. This is a very informative website.

The list of questions below may help you to better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) does a particular doctor operate from, and what are their fees. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website.

To access a list of Gynaecologists who participate in HCF’s Medicover no gap arrangement:

Please note: Participation in HCF’s no gap initiatives is at the doctor’s discretion. HCF does not guarantee that every medical service provided by these doctors will be a no gap service. Some doctors who participate in the HCF Medicover No Gap arrangement have chosen not to be listed on the HCF website. Patients are encouraged to confirm with their doctor whether they will support HCF’s no gap initiatives for their treatment.

WHAT SHOULD I ASK MY SPECIALIST?

  • Do not be afraid to ask your doctor questions about the procedure and any side effects which can occur. It is your right to know all the relevant information, as this is part of informed clinical and financial consent. Your doctor will ask you to sign a consent form.
      • Are there any other treatments that I should consider before having a hysterectomy?
      • What type of hysterectomy is best for me and why?
      • What route will you take – abdominal/vaginal/laparoscopic and why?
      • (If pre-menopausal) will the surgery induce the menopause. Should I take HRT?
      • Are there likely to be other lifestyle implications, such as an effect on sexual function?
  • In addition to what the procedure involves, you should also ask about:
  • Preparation
  • Follow up appointments, jot down any questions or concerns you may have so that you can ask your doctor at your next appointment
  • Aftercare
  • Most medication should be continued as usual, but some may interfere with the operation. Your doctor will inform you of the medication you should stop. As a guide, the following medication may require special instruction:
  • Aspirin (or any related products)
  • Blood thinners (Warfarin, heparin.)
  • Arthritis medication
  • Pain medication
  • Anti-inflammatory medication
  • Insulin

Don’t forget to mention any homeopathic or herbal remedies you are taking, as these can have interactions and side effects too.

WHERE IS IT DONE?

A hysterectomy is done in an overnight hospital. Your expected length of stay will be about 2-3 days after vaginal hysterectomy and 5-6 days after abdominal surgery.

HOW LONG IS THE PROCEDURE?

The procedure time varies considerably, but may take between 1-3 hours depending on individual circumstance.

WHO IS INVOLVED?

The people involved in the procedure are:

  • The Gynaecologist, your Specialist doctor
  • There may be an assistant surgeon
  • Anaesthetist : they give you medication that makes you relaxed and sleepy and look after you whilst the procedure is being carried out
  • Nurses for the procedure and recovery
  • Radiologist if any x-rays are necessary
  • Pathologist for blood tests and/or specimen samples

HOW DO I PREPARE FOR A HYSTERECTOMY?

Because the hysterectomy will be done under a general anaesthetic, you may need to undergo some basic tests to ensure your overall health is suitable for the procedure. This will depend on your age and health, and could include such things as an ECG (recording of your heart rhythm), chest x-ray and blood tests.

If you are a smoker and you cannot give up completely, try to reduce smoking in the weeks leading up to your surgery; this may help to lower the risk of post-operative complications such as chest infection.

You will be given medication to use as directed to clear your bowel before the operation and advised not to eat or drink for at least 6 hours before the surgery.


Please follow any instructions given to you by the Hospital. Your doctor will have his/her own specific preparation requirements as well. These instructions should be strictly followed.

WHAT DO I TAKE WITH ME TO THE HOSPITAL?

  • Do not bring any valuables with you
  • Leave all jewellery at home, a wedding ring is acceptable
  • Wear comfortable clothing
  • Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
  • Bring any relevant x-rays or scans

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

ABDOMINAL HYSTERECTOMY

For your information, the average charges for claims paid for Abdominal Hysterectomy admissions for the financial year 13/14 are provided below:

On Average

ChargeMedicare PaysHCF Pays3 If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY% of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement 4 If your doctor USES HCF’s No Gap Arrangement YOU PAY% of all admissions where your doctor USES HCF’s No Gap Arrangement
Total Average Hospital Component (accommodation, theatre and hospital related services)$6,145$0$5,884
1Medical Services Component
Anaesthetic Services$866$303$274$63145.8%$054.2%
Assistant in Operations Services$277$121$84$25527.9%$072.1%
Gynaecological Surgical Services$1,469$588$462$1,25033.5%$066.5%
Pathology Services$300$148$142$1516.4%$093.6%
Specialist Consultation$203$112$72$12215.0%$085.0%
2Total Average Medical Services$2,714$1,088$902$1,32454.6%$045.4%
Hospital and Medical Services Average for Abdominal Hysterectomy Admissions$8,859$1,088$6,786$1,32454.6%$05 45.4%

hysterectomy abdominal_14.gif

Points to Note:

  • Charges are based on HCF claims for a sample size of 538 overnight admissions with an average length of stay of 4.3 days in private participating hospitals (private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare items 35653 and 35661.

  • As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).

1 These medical services are in-patient services only.

2 The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here. Therefore, the total average medical service charge ($2,714) differs from the sum of the individual average charges as shown.

3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.

4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.

5 This percentage indicates the total coverage of hospital and medical services for all abdominal hysterectomies. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.

VAGINAL HYSTERECTOMY

For your information, the average charges for claims paid for Vaginal Hysterectomy admissions for the financial year 13/14 are provided below:

On Average

ChargeMedicare PaysHCF Pays3 If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY% of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement 4 If your doctor USES HCF’s No Gap Arrangement YOU PAY% of all admissions where your doctor USES HCF’s No Gap Arrangement
Total Average Hospital Component (accommodation, theatre and hospital related services)$5,638$0$5,369
1Medical Services Component
Anaesthetic Services$685$251$256$52034.2%$065.8%
Assistant in Operations Services$272$131$97$28415.0%$085.0%
Gynaecological Surgical Services$1,524$663$598$1,42118.6%$081.4%
Pathology Services$238$112$119$1372.9%$097.1%
Specialist Consultation$191$109$73$5713.3%$086.7%
2Total Average Medical Services$2,594$1,106$1,022$1,15939.8%$060.2%
Hospital and Medical Services Average for Vaginal Hysterectomy Admissions$8,232$1,106$6,391$1,15939.8%$05 60.2%

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Points to Note:

  • Charges are based on HCF claims for a sample size of 247 overnight admissions with an average length of stay of 3.2 days in private participating hospitals (private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 35657.

  • As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).

1 These medical services are in-patient services only.

2 The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here. Therefore, the total average medical service charge ($2,594) differs from the sum of the individual average charges as shown.

3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.

4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.

5 This percentage indicates the total coverage of hospital and medical services for all vaginal hysterectomies. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered.

2. Day of procedure

WHAT HAPPENS TO ME AT THE HOSPITAL?

When you arrive at the hospital, the admissions clerk will attend to the paperwork associated with your stay.

On admission to the hospital a nurse will orientate you to your surroundings and request your medical history, current medication and any known allergies. The consent for the operation is attended to by the surgeon. An anaesthetist will visit you prior to your operation to discuss your anaesthetic. A general anaesthetic is given which means that you are asleep throughout the procedure. You will also discuss the type of pain relief you will receive after the operation.


Sometime before theatre, you may be asked to shower with an antiseptic wash. If you are having an abdominal hysterectomy your pubic hair will need to be shaved, although this is sometimes done in theatre.

An intravenous line will be put into the back of your hand so that you can be given sedation, antibiotics and fluid replacement.

WHAT CAN I EXPECT DURING A HYSTERECTOMY?

When you arrive in the operating theatre, you will be taken into the anaesthetic bay. If not already inserted, you will have a cannula (a small plastic tube) inserted into a vein in your arm or hand. The anaesthetist will use this to inject some sedation, the first part of your general anaesthetic, after which you won’t remember anything until you wake up in recovery.

Your surgeon may use one of three techniques detailed below to perform either a partial, total or radical hysterectomy.

ABDOMINAL HYSTERECTOMY:

An abdominal hysterectomy is generally preferred when the procedure is being performed in the presence of cancer to allow for extensive exploration. It may also be required when large fibroids, multiple adhesions or endometriosis are present.

An incision of about 8-10cm is usually made across the pubic hairline, which for most women, will result in a small scar and less time for recovery than an incision down the middle of the abdomen. The uterus, and if appropriate ovaries and other organs, are removed and the area is closed with sutures or staples.

VAGINAL HYSTERECTOMY:

Removal of the uterus by this method is used when the uterus is small or a uterine prolapse is evident (where weakened pelvic floor muscles, ligaments or vaginal walls allow the uterus to move from its position in the pelvic cavity, into the vagina).

A vaginal hysterectomy is performed solely through the vagina. In the upper part of the vagina an incision is made and the uterus is removed through the vagina. This method is advantageous in that there is less pain, the hospital stay and recovery time is shorter and there is no physical scar.

LAPAROSCOPIC HYSTERECTOMY:

Laparoscopic (or “keyhole”) surgery involves making 3 or 4 small incisions in the abdomen. A laparoscope is placed through one of the incisions into the abdomen to enable the surgeon to see the pelvic organs on a video screen. The other incisions are used to allow the introduction of instruments necessary to remove the uterus through one of the incisions. The operating time may be slightly longer than an open repair but, if the surgeon is suitably skilled in the procedure, the recovery is traditionally shorter.


3. Aftercare

WHAT HAPPENS AFTER A HYSTERECTOMY?

Following the surgery, you will be taken to recovery where you will be closely monitored by nursing staff. Your vital signs will be checked on a continual basis until you are fully conscious, when you will be returned to the ward.


When you wake you will be receiving supplemental oxygen via a mask over your nose and mouth, or small plastic tubes in your nostrils. You will usually have a drip attached to the cannula in your hand or arm, which will be used to give you fluids until you are drinking normally. You will also have a catheter in your bladder so urine is drained continuously into a bag. Nursing staff will closely monitor the amount of blood you are losing vaginally.


Once back on the ward you will be helped to get out of bed and start moving as soon as you are able, in order to reduce the many complications of bed rest. You may be able to shower late on the same day if you have had a vaginal hysterectomy, but getting mobile will be more delayed following an abdominal procedure. Similarly, you will be able to start drinking fluids and build up a normal diet almost immediately following a vaginal procedure but will have to wait a day or so after an abdominal hysterectomy. This is because of increased handling, and subsequent lack of motility, of the bowel following an abdominal operation. To avoid blood clots in your legs, firm stockings are usually worn.


Your pain relief will depend on your operation and individual pain tolerance. You will commonly receive strong tablets and an injection if required. After an abdominal hysterectomy you may be given a machine called a PCA, patient controlled analgesia, which allows you to press a button and deliver small doses of a drug such as morphine into a drip in your vein. The machine is carefully programmed so that you cannot give yourself too much analgesia. After a laparoscopic hysterectomy many people experience pain in the shoulder tips, which is referred pain due to air trapped under the diaphragm.

It is important to do the pelvic floor and abdominal exercises from about the second day after your surgery, as per your doctor’s instructions prior to your surgery. Your surgeon will make an appointment to see you 6 weeks after the surgery.

Upon discharge you should be given specific advice about any self care necessary in the intervening weeks. You should be clear on the following issues:

  • Wound care
  • Level of activity, particularly heavy lifting
  • Returning to work
  • Driving (don’t forget to also check with your car insurance company in case they have any restrictions following an operation)
  • What to expect in terms of vaginal discharge
  • Pain relief, and any changes to your regular medication

You should also be advised of who to contact if you experience any problems or have any concerns. As a guide, you should seek medical assistance if you experience any of the following:

  • Swelling or redness around the incision
  • Seepage or bloody discharge from the wound
  • Fever and chills
  • Swollen abdomen
  • Pain that is not relieved by prescribed pain medication
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Disclaimer: Information is provided by HCF in good faith for the convenience of members. It is not an endorsement or recommendation of any form of treatment, nor is it a substitute for medical advice, and you should rely on the advice of your treating doctors in relation to all matters concerning your health. Every effort has been taken to ensure the accuracy of this information, however, HCF takes no responsibility for any injury, loss, damage or other consequence of the use of this information.