Women's victimization history and surgical intervention

AORN Journal,  Jan, 2003  by Debra Pilling Hastings,  Glenda Kaufman Kantor

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LITERATURE REVIEW

Studies examining the relationship between surgery and victimization have focused on acute care settings because of the frequency and severity of the acute trauma experienced by some victims of IPV. For example, two researchers reviewed data from 218 women who identified themselves as victims of IPV at an emergency department in the San Francisco area. (14) They found that more than 25% of these victims were admitted to the hospital for their injuries, and 13% required major surgical treatment.

One study examined 1,952 women who were patients in one of four community-based primary care practices in an urban area in an effort to identify the presence or history of IPV and clinical symptoms associated with IPV. (15) More than 600 of these women acknowledged experiencing abuse as a child, an adult, or both. Although patients who currently were experiencing abuse had more evidence of physical symptoms, depression, anxiety, and suicide attempts than those who had no ongoing abuse, no statistical significance was found between these two groups for number of lifetime surgeries.

Another researcher studied the impact that a history of rape or incest had on women who were recovering from a specific type of surgical intervention (ie, elective hysterectomies). (16) In this cross-sectional study, 92 women were interviewed at four established times during the postoperative period, each several months apart. The results showed a significantly higher level of depression in the first year after hysterectomy among women who had experienced sexual assault compared to women who had not. The researcher suggests that undergoing a hysterectomy could serve as a trigger to past traumatic memories of abuse. Depression might result when the victim is forced to deal not only with the surgical experience but also with the renewed memory of the abuse. Past abuse seems to leave people more vulnerable to depression and other forms of hyperarousal (ie, state in which the body overreacts to subsequent new stressors by regularly producing excessive levels of stress hormones), which might further explain these findings. There is no indication that ongoing abuse was measured in this study.

Studies of women seeking care from gastroenterology services also point to a link between victimization history and illness. In their study of 206 women seeking care in a gastroenterology practice, one group of researchers found that female patients who had experienced abuse either as adults or children (n = 89) underwent more surgeries throughout their lifetime than did patients who had not experienced abuse. (17) A history of abuse was associated with more pelvic and abdominal pain and more surgeries throughout these patients' lifetimes.

In another study, researchers interviewed 239 women seeking care at a gastroenterology clinic and found that women with a history of physical and sexual abuse (66.5%) underwent more surgeries than those who had not been abused. (18) Findings of this study indicate that assessment of abuse should be an essential component of medical histories.