Regret assessment in women under 35 years who underwent hysterectomy

Women who were properly informed before surgery do not regret their decision on hysterectomy in future.

Key Points

Highlights:

• The decision for hysterectomy is difficult both for the clinicians and the women especially under 35 years old.

 Importance:

• Women especially younger than 35 years old should be appropriately informed before hysterectomy to prevent their potential future regret for this decision postoperatively. 

What’s done here?

• This retro prospective cohort study was conducted at the two Canadian academic health science hospitals in Eastern Ontario.
• Women aged ≤35 years at the time of surgery and underwent hysterectomy for any elective benign indication at least 6 months earlier were included.
• Those who underwent hysterectomy due to the malignant, obstetrical or emergent reasons, were excluded from the study.
• The level of regret about their decision on hysterectomy as primary outcome was assessed using a five-point Likert scale.
• As the secondary outcomes, the impact of the hysterectomy on the patients’ life and the estimation of their decision process were investigated based on survey responses.

Key results:

• Of the189 women were identified who met the criteria, 71 admitted for participating in the study. The survey response rate was 74.7%.
• Patients who completed the survey were more likely to have a total laparoscopic hysterectomy.
• Menorrhagia (35.2%), uterine fibroids (22.5%), endometriosis (19.7%), and pain (15.5%) were the most common indications for hysterectomy.
• Abdominal route (38%) was the most preferred route for hysterectomy, followed by total laparoscopic (31%) and vaginal (15.5%) approaches in the patients who completed the survey.
• Overall, 91.5% of the patients did NOT have any regret about their decision for a hysterectomy at a young age.
• Most patients (85.6%) reported that their quality of life improved postoperatively.
• Over 95% of the patients also reported that the decision for hysterectomy was patient-driven or shared with the physician.

 Strengths and Limitations

• This study has an important strength since it is the first evaluation of the postoperative regret rate in women who underwent a hysterectomy at the age of 35 or younger.
• The retrospective design and the small sample size of the study can be accepted as the limitations of this study.
• These results were not generalized to all women who underwent hysterectomy younger than 35 years old, because the survey was performed only in women whom the authors could contact.

Lay Summary

Hysterectomy is the most common gynecological operation in women for the management of benign or malign indications. Leiomyomas, menorrhagia, endometriosis, and pain unresponsive to medical treatment can be accepted as the most common indications for hysterectomy.

However, hysterectomy, as the permanent loss of child-bearing capability, has several surgical risks, intraoperative and postoperative complications. Thus, the decision of hysterectomy is very difficult, especially in women under 35 years old.

Bougie et al, a group of scientists from Canada, published a study titled “Evaluating the Prevalence of Regret With the Decision to Proceed With a Hysterectomy in Women Younger than Age 35” in the journal named Journal of Obstetrics and Gynaecology Canada.

The authors aimed to assess the regret rate after surgery in women who underwent elective hysterectomy for benign indications.

There was also no statistically significant difference between the patients regarding the intraoperative or postoperative complication rates. Menorrhagia (35.2%), uterine fibroids (22.5%), endometriosis (19.7%), and pain (15.5%) were the most common indications for hysterectomy in this study. The authors found that 91.5% of the patients did NOT have any regret about their decision for hysterectomy at that age.

Most patients (85.6%) reported that their quality of life improved postoperatively. Over 95% of the patients also reported that the decision for hysterectomy was patient-driven or shared with the physician.

“We respect patient autonomy and provide appropriate support when women are contemplating this surgical option while ensuring that all available medical management options are explored,” the authors added.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/31734156