Assessment of Quality of Life after Hysterectomy using European Quality of Life Five Dimension Scale (EQ5D)

The surgical excision of the uterus, or a hysterectomy, is perhaps second most common nonobstetric procedure worldwide, right behind caesarean sections.[,] Prophylactic oophorectomy, that includes the excision of the ovaries, is occasionally advised in conjunction with hysterectomy to lower the likelihood of developing ovarian carcinoma in the long term.[] Incontinence in women,[] a lack of a feeling of femininity, sexual disturbance, a drop in libido, dyspareunia,[] late medical issues including backache and weakness, and an early onset of menopause[] are only a few of the negative effects of hysterotomies that have been documented in studies. Hysterectomy affects a woman’s quality of life in a number of ways. Some posthysterectomy women are fortunate enough to have the social support of friends and family, however not all of them.[] Quality of life following hysterectomy might be impacted by the duration of the recovery phase, the indication, and any complications that may arise following operation. If they receive enough assistance and encouragement from friends, family, and medical experts, their life quality following surgery may be improved.[,] Any type of healthcare must track and evaluate life quality. Health-related quality of life is a subjective, ephemeral notion that is challenging to quantify. The 5 aspects of mobility, self-care, typical activities, pain/discomfort, and anxiety/depression are included in the EuroQol five-dimensions–3-level (EQ5D) instrument, which is a flexible quality of life (QOL) measurement tool. It could be used to determine years of quality-adjusted life. The individual is instructed to rate their own health using a visual analogue scale (VAS) that is included with the test. Using this EQ5D measure, we sought to assess how the QOL is altered following hysterectomy so that the right actions might be done to enhance the long-term outcome.

This is an analytical observational analysis, with 250 females who underwent hysterectomy at Guru Gobind Singh medical college (GGSMC) Faridkot. All patients who consulted Obstetric and Gynecology (OBGYN) department at our hospital were assessed either by an OBGYN consultant or an OBGYN senior resident; the diagnosis and management plan were made. A Questionnaires EQ5D was used to measure recovery time period and QOL in these hysterectomized women. One day before surgery, the EQ5D tool questionnaires were given to 250 patients who were planned for hysterectomy at GGSMC Faridkot gynae department after taking consent and their willingness to participate in this study. They were telephonically called after surgery and QOL reassessed after one month and after six-month time period using same EQ5D tool questionnaire. The EQ5D descriptive system and the EQ VAS make up the majority of the EQ-5D-5L. (EQ VAS).[] A 1-digit number expressing the level chosen for that dimension, which defines the subject’s health state, is the result of this choice.

AND DISCUSSION Two hundred and eighty individuals were recruited in this trial but only two hundred and fifty of them have complete data that can be used to determine the outcome. Of the 250 cases examined, those between the ages of 40 to 49 and 50 to 59 received hysterectomies the most frequently. Type of hysterectomies performed is shown in Table 1 while complications encountered are shown in Table 2. Similar results were obtained by Medhi P et al.,[] who discovered that the average age was 406 years and that the 40 to 49 age range was the most prevalent. Research conducted in the United Kingdom revealed a similar trend. The most frequent indication in the abdominal approach was a fibroid uterus, accompanied by a Carcinoma (CA) ovary, and in the vaginal hernia it was utero vaginal prolapse.[,] Our research revealed an admirable improvement in pain and distress after a 6-month follow-up. The first component is discomfort. Although Theunissen M. Atal had used SF16 scale, that displayed improvement in pain and discomfort at the third and sixth months after surgery,[] he found that 53.6% of patients had no pain after six months of follow-up while 36.8% had mild to moderate pain and discomfort. This is in contrast to the 91.6% of patients who had pain prior to surgery. Every time a person is unwell, anxiety and depression are fairly prevalent. Prior to the surgical procedure, 92.8% of participants had intermediate to severe anxiety and depression; however, following a six-month checkup, 49.6% of individuals had no anxiety, 25.2% had mild anxiety, and 25.2% had severe anxiety and despair. Others also reported outcomes that were comparable.[] Other EQ5 components, including as mobility, self-care, and engaging in routine activities, also demonstrated improvement over preoperative condition. We discovered that 28.4% of people had some mobility issues, 23.6% had issues with self-care, and roughly 22% had trouble carrying out daily activities as shown in Table 3. After linking and examining the data, we discovered that patients who underwent surgery for any type of carcinoma had recovery rates that were slightly lesser than average. This had an impact on all EQ5D scale components, making the need for a hysterectomy one of the key factors in the success of quality improvement efforts.

Whether a hysterectomy is performed for benign or malignant disorders, the goal is typically to improve the woman’s QOL by reducing her symptoms, restoring function, and removing her anxiety that her illness will worsen and turn malignant. All EQ5D subscales significantly improved, as per the study’s findings. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

1. Hammer A, Rositch AF, Kahlert J, Gravitt PE, Blaakaer J, Søgaard M. Global epidemiology of hysterectomy:Possible impact on gynecological cancer rates. Am J Obstet Gynecol 2015;213:23–9.2. Whiteman MK, Hillis SD, Jamieson DJ, Morrow B, Podgornik MN, Brett KM, et al. Inpatient hysterectomy surveillance in the United States, 2000-2004. Am J Obstet Gynecol 2008;198:34.e1–7.3. Parker WH, Broder MS, Liu Z, Shoupe D, Farquhar C, Berek JS. Ovarian conservation at the time of hysterectomy for benign disease. Obstet Gynecol 2005;106:219–26.4. Brown JS, Sawaya G, Thom DH, Grady D. Hysterectomy and urinary incontinence:A systematic review. Lancet 2000;356:535–9.5. Dragisic KG, Milad MP. Sexual functioning and patient expectations of sexual functioning after hysterectomy. Am J Obstet Gynecol 2004;190:1416–8.6. Farquhar CM, Sadler L, Harvey SA, Stewart AW. The association of hysterectomy and menopause:A prospective cohort study. BJOG 2005;112:956–62.7. Borimnejad L, Mohadeth Ardebili F, Jozee Kabiri F, Haghani H. Comparison of quality of life after hysterectomy in pre and post menopause period in Iranian women. Iran J Obstet Gynecol Infertil 2011;13:39–45.8. Selcuk S, Cam C, Asoglu MR, Kucukbas M, Arinkan A, Cikman MS, et al. Effect of simple and radical hysterectomy on quality of life–analysis of all aspects of pelvic floor dysfunction. Eur J Obstet Gynecol Reprod Biol 2016;198:84–8.9. Radosa JC, Meyberg-Solomayer G, Kastl C, Radosa CG, Mavrova R, Gräber S, et al. Influences of different hysterectomy techniques on patients'postoperative sexual function and quality of life. J Sex Med 2014;11:2342–50.10. Balestroni G, Bertolotti G. EuroQol-5D (EQ-5D):An instrument for measuring quality of life. Monaldi Arch Chest Dis 2012;78:155–9.11. Medhi P, Dowerah S, Borgohain D. A histopathological audit of hysterectomy:Experience at a tertiary care teaching hospital. Int J Contemp Med Res 2016;3:1226–8.12. Theunissen M, Peters ML, Schepers J, Maas JW, Tournois F, van Suijlekom HA, et al. Recovery 3 and 12 months after hysterectomy:Epidemiology and predictors of chronic pain, physical functioning, and global surgical recovery. Medicine (Baltimore) 2016;95:e3980.13. Theunissen M, Peters ML, Schepers J, Schoot DC, Gramke HF, Marcus MA. Prevalence and predictors of depression and well-being after hysterectomy:An observational study. Eur J Obstet Gynecol Reprod Biol 2017;217:94–100.