Correspondence (letter to the editor): Unfortunately Without Patient Involvement

The S3 guideline in question was unfortunately compiled without involving patients (1). This possibly explains why the indication for hysterectomy itself—irrespective of the method—is neither explicitly scrutinized nor formulated as a quality target in the guideline. This is incomprehensible given that:

• Hysterectomies are performed more frequently in Germany compared with other countries—almost every 6^th woman aged between 18 and 79 years undergoes hysterectomy, with the highest case numbers being found among 45- to 50-year-olds (2).

• Persistently substantial social (3) and regional differences in treatment are known to exist on both the federal-state and the district level (4).

Regional and social differences in treatment essentially suggest quality deficiencies in terms of the indication. Approximately 50% of hysterectomies performed in Germany are for uterine fibroids, even though it is recognized that the associated symptoms generally resolve in the course of menopause without surgery.

Since the loss of an organ is often of profound significance to the woman affected, hysterectomy should always be well-founded and only performed after careful consideration together with the patient. „Shared decision making“ (SDM) was the motto of this year’s annual congress on evidence-based medicine (EbM) in Cologne, Germany, and is of central importance particularly in elective, preference-sensitive interventions such as hysterectomy for benign disease. However, the current guideline does not formulate SDM as a mandatory recommendation for routine care; instead, only in the „ideal case“ should the woman decide for herself which treatment option is best suited to her and her life situation. In light of this gap in the guideline, it is to be hoped that, from a health care policy perspective, the opportunity will be seized to offer women the planned second-opinion procedure as a standard benefit prior to elective hysterectomy.