Preoperative risk factors and their cumulative impact on nonsatisfaction after benign hysterectomy: A population-based nation-wide register study

This study aimed to determine preoperative risk factors for nonsatisfaction 1 year after hysterectomy for benign indication and to analyze whether multiple co-occurring preoperative risk factors increase the rate of nonsatisfaction.

A historical register study was conducted using data from the Swedish National Register for Gynecological Surgery of women aged 18-56 years, who underwent hysterectomy for benign conditions between 2004 and 2023. Satisfaction 1 year postoperatively was dichotomized into satisfaction or nonsatisfaction. Multiple logistic regression was used to evaluate preoperative risk factors, with results presented as adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Nagelkerke's coefficient of determination (R²) assessed the explanatory power of the models.

Among the 38 044 participating women, 3335 (8.8%) were not satisfied after 1 year. Preoperative risk factors for nonsatisfaction were smoking (aOR 1.34, 95% CI: 1.18-1.53), not being gainfully employed (aOR 1.60, 95% CI: 1.40-1.82), and the main symptoms leading to hysterectomy (pain (aOR 1.91, 95% CI: 1.70-2.15), pressure/heaviness (aOR 1.90, 95% CI: 1.53-2.21), other symptoms (aOR 2.24, 95% CI: 1.95-2.59), or several main symptoms (aOR 1.92, 95% CI: 1.53-2.41)). Protective factors for nonsatisfaction were age 46-50 years (aOR 0.87, 95% CI: 0.76-1.00) and minimally invasive hysterectomy (vaginal [aOR 0.69, 95% CI: 0.59-0.81], laparoscopic [aOR 0.79, 95% CI: 0.68-0.91], and robot-assisted laparoscopic [aOR 0.82, 95% CI: 0.71-0.95]). The likelihood of being nonsatisfied rose with the accumulation of preoperative risk factors, as reflected by the full model's explanatory power (R² = 0.141). Among individual predictors, the main symptom leading to hysterectomy contributed most to the explained variance (R² = 0.029), followed by employment status (R² = 0.009), while other factors, such as surgical route, age, and smoking only marginally contributed to the variance.

Nearly, 9% of the women were nonsatisfied with the outcome of the hysterectomy after 1 year. Lack of satisfaction appeared predictable from preoperative factors, notably smoking, not being gainfully employed, and nonbleeding symptoms leading to hysterectomy. These findings emphasize the need for individualized counseling before surgery. Given that most preoperative risk factors are resistant to immediate modification, more research is needed to develop targeted interventions that can reduce nonsatisfaction and enhance patient outcomes.