Effect of Socioeconomic Position on Patient Outcome After Hysterectomy

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Abstract

Previous studies have shown that patients with a low socioeconomic position undergoing various surgical procedures are at higher risk for postoperative complications and worse survival outcomes than patients with a high socioeconomic position. Complication and mortality rates are also higher for individuals from lower social classes treated for myocardial infarction, certain cancers, and other serious conditions. Some studies suggest an association between socioeconomic position and postsurgical complications among women undergoing hysterectomy.

This register-based cohort study was designed to determine whether there is an association between socioeconomic position and risk of complications following hysterectomy and to investigate the role of lifestyle factors and comorbidity on this association. Participants included nearly all Danish women (n = 22,150) with a benign elective hysterectomy registered in the Danish Hysterectomy Database between 2004 and 2008. The association between 3 selected measures of socioeconomic position (education, employment, and income) and complications was assessed using multiple logistic regression models. The risk of infection, hospitalization, readmission, and reoperation after hysterectomy was also examined in women of different socioeconomic status.

Complications following hysterectomy occurred in 17% of the women. The risk of infection, complications, and readmission was higher among women with less high school education and unemployed women than women with more than high school education and employed women. Unemployment (but not low education) was associated with higher odds of hospitalization of more than 4 days. Most of the social differences appeared to be due to lifestyle factors (smoking and body mass index) and comorbidity. However, the association between low education and the overall rate of complications remained unexplained. The higher odds of infection, complications, and hospitalization of more than 4 days among unemployed women could only be partially explained by differences in lifestyle and comorbidity status.

These findings show that the risk of complications following hysterectomy is significantly higher in women with a low socioeconomic position than in women with a high socioeconomic position. Differences in complications among women with low socioeconomic status can be partially explained by unhealthy lifestyle and presence of comorbidity.

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