Younger Patients Have More Regrets About Hysterectomy

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Survey indicates persistent pain and re-intervention may play a role

by
Rachael Robertson, Enterprise & Investigative Writer, MedPage Today
September 23, 2024

Patients who had a hysterectomy at age 30 or younger had higher rates of regret compared with those who had the procedure after 30, a survey-based retrospective cohort study found.

Those 30 and younger had significantly greater regret about both the surgery (32.5% vs 9.1%, P<0.001; OR 4.8, 95% CI 2.3-9.8) and loss of fertility (39% vs 13.4%, P<0.001; OR 4.1, 95% CI 2.2-7.8) compared with those 31 to 49, according to Nathan King, MD, of the University of Illinois at Chicago, and colleagues.

This age-based difference in both surgical and loss-of-fertility regret remained significant in multivariable analyses that accounted for parity, prior sterilization, previous treatment, and more (OR 2.9, 95% CI 1.3-6.5 and OR 2.8, 95% CI 1.3-6.0), they reported in Obstetrics & Gynecology.

“Overall, these data suggest that young age is an independent factor that portends regret after hysterectomy,” authors wrote.

In previous studies, hysterectomy has resulted in high levels of patient satisfaction, but most prior research focused on older patients who had abdominal hysterectomy with concurrent bilateral salpingo-oophorectomy, the authors noted. Advances in minimally invasive techniques have lowered risks and recovery times following the procedure, which can affect satisfaction.

Most patients in both age groups agreed that hysterectomy was the right choice for them, but lower rates were observed among younger patients (83.1% of those 30 and younger and 97% of those 31 and older).

Younger patients were more likely to undergo the procedure for pelvic pain compared with the older age group (77.9% vs 45.1%, P<0.001), while older patients were more likely to get a hysterectomy for uterine leiomyomas (1.3% vs 27.4%, P<0.001).

Younger patients were also more likely to experience additional pelvic pain (42.9% vs 22.6%, P<0.001) and require further gynecologic surgery (19.5% vs 3.7%, P<0.001) after hysterectomy. People who self-reported pelvic pain, a preoperative diagnosis of endometriosis, and postoperative complications all reported higher rates of surgical and loss-of-fertility regret, the researchers found.

Shira Varon, MD, of UC San Diego Health, who was not involved in the study, said that while doctors already knew that younger patients tend to regret sterilization at higher rates, “this study analyzed regret of hysterectomy for reasons other than regret of sterilization.”

For instance, the high rates of young people who needed further gynecologic surgery likely affected regret rates, she said. When counseling patients, Varon said this research shows that it’s “important to discuss rates of persistent pain and re-intervention for patients choosing hysterectomy at younger ages,” in addition to sharing rates of regret.

Varon also said the study was well conducted, but she wondered how such a high percentage were younger than 30 because she sees much lower rates in her practice, excluding gender-affirming indications. For this study, a third of participants were 30 or younger and two-thirds were between 31 and 49.

“In my practice, less than 10% of patients having hysterectomy are under the age of 30, which makes me wonder if younger patients are over-represented in this study, or if the providers performing the procedures are more apt to perform hysterectomies on young patients, and could impact the results,” Varon noted.

King and colleagues wrote that the data should be used for shared decision making rather than precluding the option of hysterectomy when deemed appropriate.

This matched retrospective cohort study included 241 participants who completed the survey (84% response rate). Eligible participants were identified from a database of adult patients who underwent hysterectomy with minimally invasive gynecologic surgeons at a single academic institution between 2009 and 2016. All patients underwent a planned laparoscopic hysterectomy, with only one conversion to an abdominal procedure. Patients were excluded if they were older than 49, had surgery for gender affirmation, were diagnosed with a malignancy, had incomplete medical records, or lived outside the U.S.

Participants completed a validated decision regret scale (DRS), which measures regret after healthcare decision making, as well as a supplementary questionnaire about their current gynecologic health. The primary outcome was differences in rates of surgical and loss-of-fertility regret among those 30 years or younger versus those 31-49 years at the time of preoperative visit. Regret was defined as a score of 30 or higher on the DRS, a level determined by past studies looking at regret in gynecologic surgery.

Most patients were white (88.8%) and the majority of non-white patients were Black (10.4%). On average, 7.2 years have passed since surgery.

Limitations included that survey data are susceptible to nonresponse and recall bias, though there was a high response rate and survey questions focused on current feelings of regret. Additionally, retrospective chart reviews can be subject to errors, though this was reduced by investigators being blinded to regret data. They also noted that this study does not reflect regret after hysterectomy by abdominal or vaginal routes and the lack of diversity in participants limits the generalizability of the results.