A University of Michigan-led study of nearly 3,400 women in Michigan shows that one in five who underwent a hysterectomy for benign conditions may not have needed it. The findings indicate that alternatives to hysterectomy are being underused and that treatment guidelines are often not followed.
Researchers found that although the numbers of hysterectomies are decreasing, nearly 18% of hysterectomies that were done for benign indications were unnecessary, and a pathology analysis for nearly two in five (38 %) of women under 40 did not support undergoing a hysterectomy.
"Over the past decade, there has been a substantial decline in the number of hysterectomies performed annually in the US," says senior author Dr Daniel M Morgan, associate professor in the department of obstetrics and gynaecology at the U-M Medical School. "An earlier study found a 36.4% decrease in number of hysterectomies performed in the US in 2010 compared to 2002. However, despite the decrease in numbers of hysterectomies in the US, appropriateness of hysterectomy is still an area of concern and it continues to be a target for quality improvement."
Researchers set out to assess how often alternatives to hysterectomy are being recommended to women with benign gynaecologic disease before performing hysterectomy and how often the pathologic findings from the hysterectomy supported an indication for surgery. They examined the medical records of 3,397 women who underwent hysterectomies for benign conditions in Michigan. Data were collected over a ten-month period in 2013 from 51 hospitals participating in the Michigan Surgery Quality Collaborative (MSQC). Indications for surgery included uterine fibroids, abnormal uterine bleeding, endometriosis, or pelvic pain.
Nearly 40% of women did not have documentation of alternative treatment before their hysterectomy. Fewer than 30% received medical therapy, while 24% underwent other minor surgical procedures before the hysterectomy. Alternative treatment was more likely to be considered among women under 40 years old and among women with larger uteri. About 68% of women under 40 received alternative treatment compared with 62% of those aged 40-50 and 56% of those aged 50 or above.
Nearly two in five women under 40 (38%) had pathologic findings that did not support undergoing a hysterectomy versus those aged 40-50 (12%) and over 50 years (7.5%). The frequency of unsupportive pathology was highest among women with endometriosis or chronic pain.
"This study provides evidence that alternatives to hysterectomy are underutilised in women undergoing hysterectomy for abnormal uterine bleeding, uterine fibroids, endometriosis, or pelvic pain," Morgan says.
[link url="http://www.uofmhealth.org/news/archive/201501/nearly-1-5-women-who-undergo-hysterectomy-may-not-need"]University of Michigan Medical School release[/link]
[link url="http://www.ajog.org/article/S0002-9378(14)02355-2/abstract"]The American Journal of Obstetrics and Gynaecology abstract[/link]