Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois; the Department of Obstetrics, Gynecology & Reproductive Sciences, UPMC Magee-Womens Hospital, and the Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania; and the Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital, Providence, Rhode Island.
Obstet Gynecol. 2024 Dec 1;144(6):757-764. doi: 10.1097/AOG.0000000000005730. Epub 2024 Sep 19.
To compare long-term decision regret between younger (30 years or younger) and older (31-49 years) patients who underwent laparoscopic hysterectomy for benign disease.
We conducted a matched retrospective cohort study to analyze patients who underwent laparoscopic hysterectomies for benign indications from 2009 to 2016. Respondents completed surveys including two validated decision regret scales: one measuring surgical decision regret and the other measuring loss-of-fertility regret. Participant aged was dichotomized as 30 years or younger and 31-49 years. Chi square, Fisher exact, and Wilcoxon rank sum tests and logistic regression were used to compare groups.
Two hundred eighty-seven participants were successfully contacted, and 241 completed the survey (84.0%). Seventy-seven respondents (32.0%) were aged 30 years or younger, and 164 (68.0%) were aged 31-49 years. The average time since surgery was 7.2 years (±2.2 years; range 3.7-12.1 years). Participants aged 30 years or younger regretted both undergoing surgery (32.5% vs 9.1%, P<.001; OR 4.8, 95% CI, 2.3-9.8) and loss of fertility (39.0% vs 13.4%, P<.001, OR 4.1, 95% CI, 2.2-7.8) at significantly higher rates than participants aged 31-49 years. Overall, 83.1% of younger participants agreed that hysterectomy was the right choice compared with 97% of older participants (P<.001). Higher rates of surgical and loss-of-fertility regret were seen in participants with self-reported pelvic pain (P=.003, P=.011), preoperative diagnosis of endometriosis (P=.037, P=.046), and postoperative complications (P=.043, P<.001). Although time since hysterectomy did not affect rate of surgical regret (P=.138), participants further from their hysterectomies had lower rates of loss-of-fertility regret (P=.003). Patient age remained significantly associated with both surgical regret (adjusted OR 2.9 (95% CI, 1.3-6.5) and loss-of-fertility regret (adjusted OR 2.8 (95% CI, 1.3-6.0) on multivariable logistic regression.
Participants aged 30 years or younger were more likely to regret their decision to undergo hysterectomy than participants aged 31-49 years, regardless of parity, prior sterilization, or previous treatment.
比较因良性疾病行腹腔镜子宫切除术的年轻（30 岁及以下）和年长（31-49 岁）患者的长期决策后悔。
我们进行了一项匹配的回顾性队列研究，分析了 2009 年至 2016 年间因良性指征行腹腔镜子宫切除术的患者。受访者完成了包括两个经验证的决策后悔量表在内的调查：一个衡量手术决策后悔，另一个衡量生育能力丧失后悔。参与者年龄分为 30 岁及以下和 31-49 岁。采用卡方检验、Fisher 确切检验、Wilcoxon 秩和检验和逻辑回归比较组间差异。
成功联系了 287 名参与者，其中 241 名完成了调查（84.0%）。77 名受访者（32.0%）年龄在 30 岁及以下，164 名（68.0%）年龄在 31-49 岁。平均手术时间为 7.2 年（±2.2 年；范围 3.7-12.1 年）。30 岁及以下的参与者后悔手术（32.5%比 9.1%，P<.001；OR 4.8，95%CI，2.3-9.8）和后悔生育能力丧失（39.0%比 13.4%，P<.001，OR 4.1，95%CI，2.2-7.8）的比例明显高于 31-49 岁的参与者。总的来说，83.1%的年轻参与者同意子宫切除术是正确的选择，而 97%的年长参与者表示同意（P<.001）。有盆腔疼痛（P=.003，P=.011）、术前诊断为子宫内膜异位症（P=.037，P=.046）和术后并发症（P=.043，P<.001）的参与者后悔手术和后悔生育能力丧失的比例更高。尽管子宫切除术的时间长短不会影响手术后悔率（P=.138），但距离子宫切除术时间越远，后悔生育能力丧失的比例越低（P=.003）。多变量逻辑回归分析显示，患者年龄与手术后悔（调整后的 OR 2.9（95%CI，1.3-6.5）和生育能力丧失后悔（调整后的 OR 2.8（95%CI，1.3-6.0）均显著相关。
无论是否生育、是否绝育或之前是否治疗，30 岁及以下的参与者比 31-49 岁的参与者更有可能后悔行子宫切除术的决定。
