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U.S. hysterectomy rates stayed constant in the 1990s and continued to be much higher than in most European countries

Every year 600,000 women in the United States undergo hysterectomy (surgical removal of the uterus and sometimes the ovaries and fallopian tubes). In fact, by the age of 60, nearly one in three women will have undergone the procedure. Despite concern about the inappropriate overuse of hysterectomy for reproductive problems, hysterectomy rates in the United States from 1990 to 1997 remained stable. However, the type of hysterectomy performed changed, according to a study by researchers at the Center for Practice and Technology Assessment, and Center for Organization and Delivery Studies, Agency for Healthcare Research and Quality.

Cynthia M. Farquhar, M.D., and Claudia A. Steiner, M.D., M.P.H., analyzed hospital discharge data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project discharge data from a 20 percent sample of U.S. community hospitals to identify all women who underwent hysterectomy from 1990 to 1997. Rates of hysterectomy for benign uterine conditions remained about the same during the study period, at 5.5 per 1,000 women in 1990 and 5.6 per 1,000 women in 1997. Abdominal hysterectomy (long incision is made in the abdomen) remained the most common procedure, accounting for 63 percent of all hysterectomies in 1997, with the most common indication being uterine fibroids. At the same time, laparoscopic hysterectomies (requiring a few small incisions in the abdomen) increased 30-fold and accounted for nearly 10 percent of hysterectomies in 1997.

Vaginal hysterectomies (incision made above the vagina)—which are associated with shorter hospital stays, reduced complications and costs, and better surgical outcomes—remained fairly constant over the 8 years. They accounted for 23 percent of the procedures in 1997, compared with 40 to 50 percent of hysterectomies in France and Australia. The introduction of alternatives to hysterectomy for controlling abnormal uterine bleeding, such as endometrial ablation, has not had an impact on hysterectomy rates, and there has only been a limited increase in laparoscopic approaches.

See "Hysterectomy rates in the United States 1990-1997," by Drs. Farquhar and Steiner, in the February 2002 Obstetrics & Gynecology 99(2), pp. 229-234.

Reprints (AHRQ Publication No. 02- R049) are available from the AHRQ Publications Clearinghouse.

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