Predictors of Hysterectomy Use and Satisfaction Miriam Kuppermann, PhD, MPH, Lee A. Learman, MD, PhD, Michael Schembri, MA, Steven E. Gregorich, PhD, Rebecca Jackson, MD, Alison Jacoby, MD, James Lewis, MD, and A. Eugene Washington, MD, MSc OBJECTIVE: To identify static and time-varying sociode- mographic, clinical, health-related quality-of-life and at- titudinal predictors of use and satisfaction with hysterec- tomy for noncancerous conditions. METHODS: The Study of Pelvic Problems, Hysterec- tomy, and Intervention Alternatives (SOPHIA) was con- ducted from 1998 to 2008. English-, Spanish-, or Chinese- speaking premenopausal women (n1,420) with intact uteri who had sought care for pelvic pressure, bleeding, or pain from an academic medical center, county hospi- tal, closed-panel health maintenance organization, or one of several community-based practices in the San Francisco Bay area were interviewed annually for up to 8 years. Primary outcomes were use of and satisfaction with hysterectomy. RESULTS: A total of 207 women (14.6%) underwent hysterectomy. In addition to well-established clinical predictors (entering menopause, symptomatic leiomyo- mas, prior treatment with gonadotropin-releasing hor- mone agonist, and less symptom resolution), greater symptom impact on sex (P.001), higher 12-Item Short Form Health Survey mental component summary scores (P.010), and higher scores on an attitude measure describing “benefits of not having a uterus” and lower “hysterectomy concerns” scores (P<.001 for each) were predictive of hysterectomy use. Most participants who underwent hysterectomy were very (63.9%) or somewhat (21.4%) satisfied in the year after the procedure, and we observed significant variations in posthysterectomy sat- isfaction across the clinical sites (omnibus P.036). Other determinants of postsurgical satisfaction included higher pelvic problem impact (P.035) and “benefits of not having a uterus” scores (P.008) before surgery and greater posthysterectomy symptom resolution (P.001). CONCLUSION: Numerous factors beyond clinical symp- toms predict hysterectomy use and satisfaction. Providers should discuss health-related quality of life, sexual func- tion, and attitudes with patients to help identify those who are most likely to benefit from this procedure. (Obstet Gynecol 2010;115:543–51) LEVEL OF EVIDENCE: II A lthough approximately 574,000 women in the United States undergo hysterectomy for noncan- cerous pelvic problems each year, 1 questions remain regarding the factors that underlie their decisions to undergo this elective procedure. Similarly, there re- mains a dearth of data from prospective studies delin- eating which women are satisfied after hysterectomy. The need to answer these critical questions, along with others, prompted the Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality) in 1994 to convene a confer- ence titled “Treatment Effectiveness of Hysterectomy and Other Therapies for Common Non-Cancerous Uterine Conditions,” during which clinical and meth- odologic experts reviewed the evidence on the use and effectiveness of hysterectomy and other treat- ments to make recommendations for research in this area. 2 The conferees concluded that prospective stud- ies were needed to investigate the natural history of From the Departments of Obstetrics, Gynecology and Reproductive Sciences, Epidemiology and Biostatistics, and Medicine, and the Medical Effectiveness Research Center for Diverse Populations, University of California, San Fran- cisco; and the Department of Obstetrics and Gynecology, Kaiser Permanente, San Francisco, California. Supported by grants from the Agency for Healthcare Research and Quality (U01 HS09478, R01 HS011657, U01 HS07373) and the National Institute on Aging and Office of Research in Women’s Health, National Institutes of Health (U01 HS09478). The funding sources had no role or involvement in the design and conduct of the study; the collection, management, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript. Corresponding author: Miriam Kuppermann, PhD, MPH, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 3333 California Street, Suite 335, San Francisco, CA 94143-0856; e-mail: kuppermannm@obgyn.ucsf.edu. Financial Disclosure The authors did not report any potential conflicts of interest. © 2010 by The American College of Obstetricians and Gynecologists. Published by Lippincott Williams & Wilkins. ISSN: 0029-7844/10 VOL. 115, NO. 3, MARCH 2010 OBSTETRICS & GYNECOLOGY 543