Objective To examine the association between socioeconomic status (SES) and eight selected surgical outcomes after hysterectomy and asses the role of lifestyle, co-morbidity and clinical conditions on the relationship.
Methods All 22 150 women registered with a benign elective hysterectomy code in the national Danish Hysterectomy Database (DHD) from 2004 to 2008 were included in the study. Data from DHD were linked to several central registers providing information on education, employment, income, lifestyle factors, co-morbidities and surgical outcome. Data were analysed using multilevel logistic regression models.
Results Overall 17% of the women experienced a clinical complication in relation to hysterectomy. Four per cent were re-operated, 6% readmitted and 6% experienced prolonged hospitalisation ≥5 days. Women with short education had a higher risk of complications than women with higher education after adjusting for patient characteristics (OR=1.15, 95% CI 1.02 to 1.31). They also had a higher risk of peroperative bleeding after adjusting for lifestyle factors and co-morbidity (OR=1.60, CI 1.15 to 2.22). Furthermore, a higher risk of infection and readmission was observed however, these relations seemed fully explained by lifestyle factors and co-morbidity. Women out of employment had a higher risk of infection, organ lesion, prolonged hospitalisation and readmission than women in employment. We found no association between income and surgical outcome after hysterectomy.
Conclusion This study suggests that women with low SES have a significant worse surgical outcome after hysterectomy than women with high SES when differences in lifestyle factors and co-morbidity are taking into account.
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