Predictors of hysterectomy use and satisfaction.
OBJECTIVE
To identify static and time-varying sociodemographic, clinical, health-related quality-of-life and attitudinal predictors of use and satisfaction with hysterectomy for noncancerous conditions.


METHODS
The Study of Pelvic Problems, Hysterectomy, and Intervention Alternatives (SOPHIA) was conducted from 1998 to 2008. English-, Spanish-, or Chinese-speaking premenopausal women (n=1,420) with intact uteri who had sought care for pelvic pressure, bleeding, or pain from an academic medical center, county hospital, closed-panel health maintenance organization, or one of several community-based practices in the San Francisco Bay area were interviewed annually for up to 8 years. Primary outcomes were use of and satisfaction with hysterectomy.


RESULTS
A total of 207 women (14.6%) underwent hysterectomy. In addition to well-established clinical predictors (entering menopause, symptomatic leiomyomas, prior treatment with gonadotropin-releasing hormone agonist, and less symptom resolution), greater symptom impact on sex (P=.001), higher 12-Item Short Form Health Survey mental component summary scores (P=.010), and higher scores on an attitude measure describing "benefits of not having a uterus" and lower "hysterectomy concerns" scores (P<.001 for each) were predictive of hysterectomy use. Most participants who underwent hysterectomy were very (63.9%) or somewhat (21.4%) satisfied in the year after the procedure, and we observed significant variations in posthysterectomy satisfaction across the clinical sites (omnibus P=.036). Other determinants of postsurgical satisfaction included higher pelvic problem impact (P=.035) and "benefits of not having a uterus" scores (P=.008) before surgery and greater posthysterectomy symptom resolution (P=.001).


CONCLUSIONS
Numerous factors beyond clinical symptoms predict hysterectomy use and satisfaction. Providers should discuss health-related quality of life, sexual function, and attitudes with patients to help identify those who are most likely to benefit from this procedure.
Kuppermann
Miriam
M
From the Departments of Obstetrics, Gynecology and Reproductive Sciences, Epidemiology and Biostatistics, and Medicine, and the Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco; and the Department of Obstetrics and Gynecology, Kaiser Permanente, San Francisco, California.
Learman
Lee A
LA
Schembri
Michael
M
Gregorich
Steven E
SE
Jackson
Rebecca
R
Jacoby
Alison
A
Lewis
James
J
Washington
A Eugene
AE
D000046:Academic Medical Centers; D000328:Adult; D001294:Attitude to Health; D017558:Elective Surgical Procedures; D005260:Female; D006279:Health Maintenance Organizations; D006766:Hospitals, County; D006801:Humans; D007044:Hysterectomy; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008796:Metrorrhagia / Q000150:complications / Q000523:psychology / Q000601:surgery; D008875:Middle Aged; D017060:Patient Satisfaction; D017699:Pelvic Pain / Q000150:complications / Q000523:psychology / Q000601:surgery; D011788:Quality of Life; D012735:Sexual Dysfunction, Physiological / Q000523:psychology / Q000601:surgery