Use of other treatments before hysterectomy for benign conditions in a statewide hospital collaborative

Lauren E. Corona, Carolyn W. Swenson, Swenson CW, Kyle H. Sheetz, Sheetz KH, Gwendolyn Shelby, Shelby G, Mitchell B. Berger, Mark D. Pearlman, Pearlman MD, Campbell DA Jr, Darrell A. Campbell, John Oliver DeLancey, DeLancey JO, John O DeLancey, Daniel M. Morgan
American journal of obstetrics and gynecology · 2014 · vol. 212(3) , pp. 304.e1–304.e7 · doi:10.1016/j.ajog.2014.11.031 · PMID:25542564 · W2027880378
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This study analyzed the use of various treatments prior to hysterectomy for benign conditions within a statewide hospital collaborative.

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Abstract

ObjectiveWe sought to analyze use of alternative treatments and pathology among women who underwent hysterectomy in the Michigan Surgical Quality Collaborative.Study designPerioperative hysterectomy data including demographics, preoperative alternative treatments, and pathology results were analyzed from 52 hospitals participating in the Michigan Surgical Quality Collaborative from Jan. 1 through Nov. 8, 2013. Women who underwent hysterectomy for benign indications including uterine fibroids, abnormal uterine bleeding (AUB), endometriosis, or pelvic pain were eligible. Pathology was classified as "supportive" when fibroids, endometriosis, endometrial hyperplasia, adenomyosis, adnexal pathology, or unexpected cancer were reported and "unsupportive" if these conditions were not reported. Multivariable analysis was done to determine independent associations with use of alternative treatment and unsupportive pathology.ResultsInclusion criteria were met by 56.2% (n = 3397) of those women who underwent hysterectomy (n = 6042). There was no documentation of alternative treatment prior to hysterectomy in 37.7% (n = 1281). Alternative treatment was more likely to be considered among women aged 50 years (68% vs 62% vs 56%, P < .001) and among women with larger uteri. Unsupportive pathology was identified in 18.3% (n = 621). The rate of unsupportive pathology was higher among women age 50 years (37.8% vs 12.0% vs 7.5%, P < .001), among women with an indication of endometriosis/pain vs uterine fibroids and/or AUB, and among women with smaller uteri.ConclusionThis study provides evidence that alternatives to hysterectomy are underutilized in women undergoing hysterectomy for AUB, uterine fibroids, endometriosis, or pelvic pain. The rate of unsupportive pathology when hysterectomies were done for these indications was 18%.

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MeSH descriptors

Hysterectomy Unnecessary Procedures Uterine Diseases Adult Aged Age Factors Combined Modality Therapy Contraindications Female Humans Hysterectomy Logistic Models Michigan Middle Aged Quality Assurance, Health Care Unnecessary Procedures Uterine Diseases Uterine Diseases Uterine Diseases

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