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This study analyzed annual rates, types, and indications for hysterectomies performed on benign conditions among 32,321 women enrolled in Kaiser Permanente Northern California between 1994 and 2003. The researchers found a significant 15% overall decline in hysterectomy rates, driven by reductions in procedures for uterine leiomyoma, endometriosis, and uterine prolapse, while the proportion of subtotal abdominal hysterectomies increased threefold. Although the authors noted that the specific reasons for this downward trend were unclear, they highlighted that uterine leiomyoma remained the most common indication throughout the decade. Relevance to endometriosis: listed as one of the primary benign indications for hysterectomy, with the paper reporting a 33.1% decrease in procedure rates for this condition during the study period.
Abstract
More than 600,000 hysterectomies are done each year, making this the most common major nonobstetric operation performed on women in the United States. This study was an attempt to determine annual rates, types, and indications for hysterectomy done on benign indications. The study population consisted of 32,321 hysterectomies done for benign conditions in women at least 20 years of age in the years 1994 to 2003. All women had been enrolled for a year or longer in Kaiser Permanente Northern California. Rates of hysterectomy decreased significantly by 15%, from 4.01 per 1000 women in 1994 to 3.41 per 1000 in 2003. This trend held for abdominal and vaginal hysterectomies as well as laparoscopy-assisted vaginal hysterectomy (LAVH). The relative proportions of both vaginal hysterectomy and LAVH, especially the latter, declined during the years under review. The relative proportion of total abdominal hysterectomy also declined, but that of subtotal abdominal hysterectomy increased 3-fold. Hysterectomy was done for uterine leiomyoma more often than for all other indications combined in each of the years under review. Rates of hysterectomy decreased 11.2% for uterine leiomyoma, 33.1% for endometriosis, and 18.6% for uterine prolapse. Hysterectomies done for “other” indications declined 5.7%. Rates of hysterectomy were consistently highest for women 40 to 44 and 45 to 49 years of age. The increase in rates for these age groups was not statistically significant, however. Rates for all other age groups decreased significantly over time. Uterine leiomyoma was the most common indication for hysterectomy in women aged 35 to 54 years and uterine prolapse in those aged 55 and older. Rates of hysterectomy for benign disease declined significantly in this large population, but the reasons are not clear. Studies focusing on the potential effects of alternative surgical procedures and medical treatments on rates of hysterectomy would be of interest.
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Hysterectomy Rates for Benign Indications
- Gavin F. Jacobson
- Ruth E. Shaber
- Mary Anne Armstrong
- Yun-Yi Hung
More than 600,000 hysterectomies are done each year, making this the most common major nonobstetric operation performed on women in the United States. This study was an attempt to determine annual rates, types, and indications for hysterectomy done on benign indications. The study population consisted of 32,321 hysterectomies done for benign conditions in women at least 20 years of age in the years 1994 to 2003. All women had been enrolled for a year or longer in Kaiser Permanente Northern California.
Rates of hysterectomy decreased significantly by 15%, from 4.01 per 1000 women in 1994 to 3.41 per 1000 in 2003. This trend held for abdominal and vaginal hysterectomies as well as laparoscopy-assisted vaginal hysterectomy (LAVH). The relative proportions of both vaginal hysterectomy and LAVH, especially the latter, declined during the years under review. The relative proportion of total abdominal hysterectomy also declined, but that of subtotal abdominal hysterectomy increased 3-fold. Hysterectomy was done for uterine leiomyoma more often than for all other indications combined in each of the years under review. Rates of hysterectomy decreased 11.2% for uterine leiomyoma, 33.1% for endometriosis, and 18.6% for uterine prolapse. Hysterectomies done for “other” indications declined 5.7%. Rates of hysterectomy were consistently highest for women 40 to 44 and 45 to 49 years of age. The increase in rates for these age groups was not statistically significant, however. Rates for all other age groups decreased significantly over time. Uterine leiomyoma was the most common indication for hysterectomy in women aged 35 to 54 years and uterine prolapse in those aged 55 and older.
Rates of hysterectomy for benign disease declined significantly in this large population, but the reasons are not clear. Studies focusing on the potential effects of alternative surgical procedures and medical treatments on rates of hysterectomy would be of interest.
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