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Predictors of Persistent Pain After Hysterectomy for Chronic Pelvic Pain: A Systematic Review
Meenal Misal1, Ethan M Balk, Megan S Orlando
1Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio; Brown University School of Public Health, Providence, Rhode Island; the Department of Obstetrics and Gynecology, University of Colorado, Aurora, Colorado; the Department of Obstetrics and Gynecology, University of California, San Diego, San Diego, California; the Division of Female Pelvic Medicine & Reconstructive Surgery University of Louisville Health, Louisville, Kentucky; the Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, the University of Texas Southwestern Medical Center, Dallas, and the Division of Minimally Invasive Gynecology Surgery, Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, Houston, Texas; the Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida; and the Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, New York, New York.
Objective:
To systematically review predictors associated with persistent pain after hysterectomy performed for individuals with chronic pelvic pain.
Data Sources:
PubMed and EMBASE were queried from inception to July 2, 2024, searching for human subject studies investigating hysterectomy performed for chronic pelvic pain.
Methods Of Study Selection:
Double independent screening for studies of chronic pelvic pain was performed by members of the Systematic Review Group of the Society of Gynecologic Surgeons. We included longitudinal observational studies (prospective or retrospective) and randomized controlled trials (RCTs). Data were extracted with risk-of-bias assessment with the Cochrane Risk of Bias tool and the Risk of Bias in Nonrandomized Studies of Interventions tool. Extractions were reviewed by a second researcher. We conducted restricted maximum-likelihood meta-analyses of effect sizes as feasible.
Tabulation, Integration, And Results:
One RCT and six cohort studies met the inclusion criteria. The overall quality of the studies was fair to good. The incidence of persistent pelvic pain after hysterectomy ranged widely, from 12% to 68%. Younger age was associated with increased likelihood of persistent pain after hysterectomy (summary odds ratio [OR] 1.39, 95% CI, 1.11-1.75; five studies, N=11,165). Ovarian conservation was not significantly associated with persistent pain (OR 2.04, 95% CI, 0.67-6.18; three studies). Endometriosis was variably associated with persistent pain, with two studies finding an association (summary OR 1.18, 95% CI, 1.06-1.31), whereas two other studies found that stage III or greater endometriosis was not associated with persistent pain (summary OR 0.99, 95% CI, 0.45-2.21). Multiple predictors of interest were evaluated by single studies, limiting the ability to draw aggregate conclusions.
Conclusion:
High proportions of patients undergoing hysterectomy for chronic pelvic pain experience persistent postoperative pain. Although there is heterogeneity among study design and clinical factors examined and some associations should be interpreted with caution, persistent pelvic pain was associated with younger age at the time of hysterectomy.
Systematic Review Registration:
PROSPERO, CRD42024530836.
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