The place of hysterectomy in the management of benign uterine disease.
The wide variation in hysterectomy rates may reflect professional uncertainty as to the appropriateness of the procedure for managing benign uterine disease. This is thought to be due to diagnostic difficulties and especially to a lack of outcomes data. Many patients experience symptomatic relief after hysterectomy, but the long-term costs and benefits remain uncertain. Alternative treatments are available that spare the uterus and/or ovaries and appear to be as effective as hysterectomy. Vaginal hysterectomy is also associated with significantly reduced hospitalization and convalescent time and a lower rate of post-operative complications compared to abdominal hysterectomy, yet most hysterectomies continue to be performed abdominally. Based on the review, a number of steps are proposed for dealing with the problem of excess hysterectomy rates within a managed care setting.
Mawson
A R
AR
CIGNA HealthCare of Louisiana, Baton Rouge, USA.
D004717:Endometrium / Q000601:surgery; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006279:Health Maintenance Organizations; D006801:Humans; D007044:Hysterectomy / Q000379:methods / Q000706:statistics & numerical data*; D053685:Laser Therapy; D008872:Microwaves; D017410:Practice Guidelines as Topic; D014481:United States / Q000453:epidemiology; D014591:Uterine Diseases / Q000601:surgery* / Q000628:therapy