Satisfaction with Hysterectomy: Low-Income, Under-Insured Teaching Hospital Patients Versus Insured Patients at a Private Hospital
Drs. James B. Unger, Gloria Caldito, Joseph Sams, Jack F. Perrone, Edwin Byrd
Louisiana State University Health Sciences Center
Shreveport, Louisiana

Objective: To compare patient satisfaction and health related quality of life in a group of low-income women after hysterectomy at a teaching hospital with a group of insured women at a private hospital.
Materials and Methods: A validated health related quality of life outcomes questionnaire (Menorrhagia Outcomes Questionnaire-Short Form) was mailed to two groups of women 3 months after hysterectomy for benign disease. Group 1 consisted of 50 low-income women having their hysterectomy on the gynecology housestaff service at Louisiana State University Hospital. Group 2 consisted of 50 women with private health insurance undergoing hysterectomy by their own physician at a local private hospital. A total health related quality of life/satisfaction score was then calculated for each woman based on her responses to the 12 items making up the index. This total score has a defined mean of 50±10, with a lower score indicating a better outcome. Potentially confounding variables were identified and accounted for using a general linear analysis: total outcome score = group effect + effects of covariates. A variable was identified as a possible confounder if it was significantly associated with the total score, group membership, or both. Overall symptom relief with hysterectomy was also compared between groups. The two-sample t-test and analysis of variance was used to compare continuous data while the chi-square test was used to analyze categorical variables. P value < .05 was significant.
Results: Overall, 98% of women in Group 1 and 100% of women in Group 2 noted improvement in their preoperative complaints. There was no difference between groups for operative indications. The total outcome satisfaction score was significantly worse for Group1 compared to Group 2, 51.3±7.4 vs. 48.7±4.2, t(1) = -2.1, p = .04 Although, in Group 1 there were significantly more African-American women  (60% vs.12% for Group 2, p=.001), and more women without a partner  (52% vs. 24% for Group 2, p=.004), neither of these affected total outcome. Although there were fewer abdominal hysterectomies in Group 1 compared to Group 2 (64% vs. 90%, p=.002) and more women in Group 2 than Group 1started hormonal therapy post-operatively, (72% vs. 48%, p=.01), neither of these affected total satisfaction score when other factors were controlled for.
Conclusion: Hysterectomy is very effective at treating the symptoms and conditions that lead women to hysterectomy. However, low-income women having hysterectomy at a teaching hospital experience lower post-hysterectomy satisfaction than women cared for in a private hospital.
Key words: hysterectomy, health-related quality of life, satisfaction