Hysterectomy and gallstone risk in women: A cross-sectional NHANES study on the mediating role of metabolic disorders.

Hysterectomy is a common gynecological procedure, with growing evidence suggesting potential long-term metabolic consequences. Gallstone disease (GSD) is a prevalent condition strongly linked to metabolic disturbances. However, the direct association between hysterectomy and GSD, and the potential mediating role of metabolic disorders, remains inadequately explored. This cross-sectional study analyzed data from 5317 female participants (aged ≥ 20) in the National Health and Nutrition Examination Survey cycles 2017 to 2023. The association between self-reported hysterectomy and GSD was assessed using weighted multivariable logistic regression, adjusting for sociodemographic, lifestyle, and clinical factors. Subgroup and E-value analyses evaluated heterogeneity and robustness. Mediation analysis quantified the contributions of body mass index, hypertension, hyperlipidemia, and diabetes. A history of hysterectomy was significantly associated with increased odds of GSD (fully adjusted odds ratio = 1.32, 95% confidence interval: 1.10-1.59). The association was more pronounced in women with lower socioeconomic status. Mediation analysis revealed that body mass index (proportion mediated: 16.5%), diabetes (13.9%), and hypertension (6.5%) were significant mediators, whereas hyperlipidemia was not. Hysterectomy is independently associated with a higher prevalence of gallstones in Unites States women. This association is partially mediated through metabolic pathways, particularly obesity and diabetes. These findings highlight the importance of postoperative metabolic monitoring and management for women undergoing hysterectomy to mitigate long-term GSD risk.