Predictors of Hysterectomy in Women with Common Pelvic Problems: A Uterine Survival Analysis
Received 27 September 2006; received in revised form 22 December 2006; accepted 2 January 2007. published online 23 February 2007.
Background
Comprising over 600,000 patients per year, hysterectomy is the most common nonobstetrical operation performed in US women. Little is known about the natural history of the noncancerous uterine conditions leading to hysterectomy. We followed a prospective cohort of women with common pelvic problems to determine whether simple clinical characteristics could predict a subsequent hysterectomy.
Study Design
We recruited 762 women seeking care for abnormal uterine bleeding, chronic pelvic pain, or symptomatic uterine fibroids and ascertained their hysterectomy status during 4 years of surveillance. We collected baseline patient-reported sociodemographic and clinical data and fit Cox models to predict the effects of covariates on hysterectomy across patient age.
Results
There were 99 hysterectomies, resulting in 0.044 hysterectomies per person-year of observation and a 13.5% cumulative hysterectomy rate. Hysterectomy was independently predicted by multiple pelvic symptoms or symptomatic fibroids (hazard ratio [HR], 1.97; 95% CI, 1.18−3.28), previous use of a gonadotropin-releasing hormone agonist (HR, 2.54; 95% CI, 1.53−4.24), and an absence of symptom resolution (HR, 2.24; 95% CI, 1.46−3.44). Survival curves plotted for subgroups with combinations of these predictors showed an escalating risk of hysterectomy with each additional risk factor. Predicted hysterectomy rates ranged from 20%, if all 3 predictors were absent, to 95%, if all 3 were present.
Conclusions
For women with common pelvic problems, three easily measured clinical characteristics (symptom combination, degree of resolution, and earlier use of a gonadotropin-releasing hormone agonist) predict the likelihood of subsequent hysterectomy and can be used to inform counseling about the likely success of alternative treatments.
⁎Department of Obstetrics, Gynecology and Reproductive Sciences and Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, School of Medicine, San Francisco, CA
†Department of Medicine and Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, School of Medicine, San Francisco, CA
‡Kaiser Permanente Medical Group, San Francisco, CA.
Correspondence address: Lee A Learman, MD, Department of Obstetrics and Gynecology, University of California, San Francisco School of Medicine, 1001 Potrero St, Room 6D-9, San Francisco, CA 94110.
Competing Interests Declared: None.
Supported by grants from the Agency for Healthcare Research and Quality (U01 HS09478, R01 HS011657, U01 HS07373), National Institute on Aging (U01 HS090478) and Office of Research in Women’s Health, and National Institutes of Health (U01 HS090478).
ABSTRACT