Hysterectomy increasingly has been recognized as a procedure that can affect many aspects of a woman's health. The importance of the various health outcomes related to hysterectomy varies according to perspective. For a woman considering hysterectomy, the outcomes of interest include its effectiveness for relief of symptoms, duration of hospitalization and recuperation, and long-term effects on quality of life, including mental health and sexual function. Clinicians are concerned as well with the rate of complications and mortality after hysterectomy and the potential for longterm benefits and risks, such as its effects on endocrine function, cardiovascular disease, and cancer. Health policy makers have critically considered hysterectomy from the standpoint of healthcare costs, reflected in hospital length of stay and use of healthcare resources after surgery.
Despite the fact that hysterectomy has been the most frequent nonobstetric surgical procedure in the United States for the past three decades, it is only within the past few years that researchers have begun to systematically assess its outcomes. Previously published data on hysterectomy were limited largely to reports of surgical complications and mortality rates and retrospective epidemiologic studies. The latter group generated numerous hypotheses about possible long-term effects of hysterectomy, but lacked the methodologic power to accurately assess causation. Recently several randomized trials and prospective cohort studies have provided valuable new information on the short-and medium-term health outcomes of hysterectomy. In addition, epidemiologic studies of its long-term consequences have matured, allowing better estimation of outcomes that could not be measured feasibly with other methods.
This article considers the spectrum of health outcomes after hysterectomy, focusing mainly on hysterectomy for nonmalignant disease, which accounts for approximately 90% of hysterectomies. Outcomes related to use of healthcare resources after hysterectomy are addressed; however, an analysis of the economic outcomes of hysterectomy is beyond the scope of this article. Quality-of-life outcomes of hysterectomy are considered further in another article in this series.
Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
Correspondence: Karen J. Carlson, MD, Medical Practices Evaluation Center, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02114 Supported in part by a grant (RO1 HS06121) from the Agency for Health Care Policy and Research.