Exploring the relationship between hysterectomy and pelvic organ prolapse risk: a cross-sectional analysis using NHANES data

Objective: To assess the association between hysterectomy and prevalence of pelvic organ prolapse (POP) using data from the National Health and Nutrition Examination Survey (NHANES) 2005–2012, and to develop a predictive model for individualized POP probability. Methods: We analyzed the data of 8,536 women, 309 of whom had POP. Survey-weighted multivariable logistic regression analyses were performed to evaluate the independent association between hysterectomy and POP risk. A POP prediction model incorporating age, race, body mass index (BMI), parity, socioeconomic status, and comorbidities was developed using LASSO regression. Model performance was validated using the bootstrap method. Results: Hysterectomy was independently associated with higher odds of POP after adjusting for confounders (OR = 1.59, 95% CI: 1.10-2.30). The model validation showed excellent calibration. Subgroup analyses confirmed consistent associations across various demographic and clinical strata. A predictive model using ten key variables demonstrated promising results. Conclusions: Hysterectomy was independently associated with an increased prevalence of POP, and this association remains consistent across clinical and demographic subgroups. The development of a clinical nomogram incorporating key predictors of POP risk may aid clinicians in risk stratification and preoperative counseling. Well-designed longitudinal and interventional studies are needed to clarify the causal impact of hysterectomy on subsequent POP and to refine preventive strategies at the index surgery, particularly standardized apical support restoration.