Description of Patterns and Exploration of Risk Factors for Regret One Year After Hysterectomy: A Longitudinal Prospective Study
Sangha R, Bossick A, Coleman C, Su WT, and Wegienka G. Description of Patterns and Exploration of Risk Factors for Regret One Year After Hysterectomy: A Longitudinal Prospective Study. J Minim Invasive Gynecol 2019; 26(7):S68.
J Minim Invasive Gynecol
Study Objective: To describe patterns of regret up to one year after hysterectomy and analyze associated risk factors Design: Prospective cohort study, USPSTF II-2 Setting: Henry Ford Health System, Detroit, MI Patients or Participants: Women who had planned to have a hysterectomy for non-cancer reasons, were recruited via telephone. Interventions: Before and after hysterectomy, patients were administered validated surveys. The Patient Health Questionnaire-9 (PHQ-9) to measure depression severity. The Decision-Regret Scale for regret and the Comprehensive score for Financial Toxicity. Measurements and Main Results: 459 women were enrolled, 91.9% completed questionnaires about their health and decision to have a hysterectomy within 14 days prior to surgery and at 3,6 and 12-months post-surgery. The latent class model investigated regret trajectories over time. Demographic and operative characteristics by latent class group were analyzed using Chi-squared test and one-way ANOVA. Of these hysterectomies, 28.5% were via abdominal route. Three groups were identified by their patterns of repeated measured of self-reported regret (p<0.0001). Group 1 (7.41%) had the highest level of regret at baseline which increased further to a high one year after surgery. Group 2 (13.3%), had the same baseline level of regret as group 1, which rapidly declined right after. The largest group, Group 3, (79.4%) had the lowest regret score at baseline and a similar overall trajectory as group 2, with the lowest overall regret one year after surgery. Important differences were found with regards to pain, depression, surgery satisfaction, insurance type, race and financial toxicity. Differences were however not found for route of surgery, BMI, age, length of stay, procedure duration, estimated blood loss, complications, concomitant oophorectomy, uterine weight, and indication for surgery. Conclusion: This study emphasizes exploring pain and depression during preoperative counseling. Understanding that race, insurance type and financial toxicity may impact patient-perceived outcomes like regret after hysterectomy, could help reduce long-term regret after hysterectomy.