Hysterectomy in a decade of change: more than a weighty matter.
Objective: Hysterectomy is the second most common surgical procedure performed in the United States. Interest to decrease use of hysterectomy has focused on developing explicit criteria for surgery, peer review and second opinion, as well as changing reimbursement incentives. The purpose of this study is to describe the change in the number of hysterectomies, the indications for hysterectomies, and the histopathology of hysterectomy specimens over the last 10 years at one private, nonprofit, academic, community hospital that does not have a formal system for monitoring hysterectomy use.Methods: Retrospective study utilizing administrative data matched with pathology reports for nonmalignant hysterectomies performed in 1985, 1990, and 1995. Uterine weight and histopathologic diagnoses were recorded. When pathology reports were unavailable, cases were reviewed to determine if the indication was related to prolapse or urinary incontinence. Outcome measures included number of procedures performed, indications for procedures and uterine pathology (uterine weight, histopathology). We utilized the Cochran-Mantel-Haenszel chi(2) and the Kruskal-Wallis rank sum statistic (P <.05).Results: The number of hysterectomies declined from 631 in 1985 to 461 in 1995 (P =.007). The median uterine weight increased (P =.0007), and there was a decrease in the number of specimens with absent histopathology, decreasing from 6% in 1985 to 3% in 1995 (P =.013). This difference was explained by changes in the number of procedures performed on patients with private insurance and HMO reimbursement (P =.018).Conclusions: While the proportion of surgeries performed for specific indications did not change, the number of hysterectomies performed decreased, and there were fewer normal specimens.
Kirk
JH
Department of Obstetrics & Gynecology, Cedars Sinai Medical Center & UCLA School of Medicine, USA
Karlan
BY
Cane
P
Gregory
K