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Am Fam Physician. 2000;62(6):1375-1376

Most women benefit from hysterectomy for nonmalignant uterine conditions; however, a small number report no improvement in symptoms postoperatively, and some report additional problems. Kjerulff and associates reviewed the outcomes of hysterectomy to identify factors associated with poor postoperative symptom relief, psychologic function and quality of life.

Physicians performing hysterectomies in 28 hospitals in Maryland were asked to identify adult women scheduled to undergo hysterectomy for a benign indication. All patients were interviewed before surgery and again at three, six, 12, 18 and 24 months postoperatively. The principal diagnosis and reported symptoms were documented at these interviews. Eight symptoms were included: vaginal bleeding, pelvic pain, fatigue, back pain, abdominal bloating, sleep disturbance, urinary incontinence and activity limitation. Each symptom was evaluated using a quantitative scale. Standardized scales also were used to assess psychologic function, quality of life and overall general health. Operative and postoperative complications were assessed from patient records.

The study initially enrolled 1,299 women, but the attrition rate over two years was 10.6 percent, primarily because of lack of interest in participating in follow-up assessments. Black women and women of low income were more likely to drop out during the follow-up period. The principal diagnoses leading to hysterectomy were uterine leiomyomas (48 percent), menstrual disorders (16.5 percent), uterine prolapse (13.2 percent) and endometriosis (8.6 percent). Only 21.4 percent of the patients reported no complications during hospitalization, and more than two thirds reported one or more mild complications during the same period. Nine women (0.7 percent) had serious complications, and 48 (4 percent) were readmitted to a hospital within the year following surgery because of conditions related to hysterectomy. The most common serious complications were related to the incision or urinary tract problems.

Most women reported significant relief of symptoms following hysterectomy, but some did not. For a list of symptoms reported to be problematic before and after surgery, see the accompanying table. At one year, more than 99 percent of women reported relief of vaginal bleeding, but only 62 percent of those reporting poor general health before surgery perceived any improvement postoperatively. Statistical analyses suggested that race, age and education were not significantly related to poor outcomes, although higher income was correlated with good outcome. Conversely, a history of depression and therapy at baseline was significantly related to poor outcome. The only operative variable related to outcome was bilateral oophorectomy, which was related to poor outcome.

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The authors conclude that a small percentage of women do not achieve symptom relief following hysterectomy. Low income and a history of depression at baseline appear to be related to a poor outcome. They also emphasize the importance of inquiring about these and other factors in patients' lives before counseling them to undergo hysterectomy for relief of symptoms.

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