EFFECTIVENESS AND OUTCOMES OF HYSTERECTOMY

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Hysterectomy is the second most frequent major surgery in the United States, second only to cesarean section. Thirty-seven percent of women in the United States aged 60 or over have had a hysterectomy. Estimates of the complication rate for hysterectomy range from 20% to 50% and include operative and postoperative hemorrhage, wound infection, cystitis and associated infections and surgical damage to adjacent organs. Longer term consequences include sexual dysfunction, depression, fatigue, vertigo, sleeping problems and urinary and bowel problems. Black women have higher rates of hysterectomy, higher complication rates and twice the mortality rate than for White women undergoing hysterectomy. The objectives of the proposed study are to address several gaps in the literature as concerns hysterectomy. These objectives are 1.) To conduct a 2 year prospective study of 1,000 women receiving hysterectomy in the State of Maryland, with patient interviews prior to surgery and at 5 points in time after surgery (3, 6, 12, 18, and 24 months), as well as chart review and physician interview, in order to examine the decision making process and outcomes of hysterectomy focusing on mortality, morbidity, health status, functional capacity, and quality of life, 2.) to examine the extent to which surgical procedure (vaginal vs abdominal) and ovary removal affect outcomes, 3.) to examine the extent to which patient race and other socioeconomic factors affect the decision making process and outcomes of hysterectomy.