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Women's Health

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Practice patterns for hysterectomy changed during the early 1990s

Although the United States has the highest hysterectomy rate in the world, with over half a million procedures performed annually in the early 1990s, hysterectomy rates have declined steadily since the 1980s. There also have been changes in the surgical technique, including the reintroduction of supracervical hysterectomy, which leaves the cervix in place.

According to a study by E. Scott Sills, M.D., of the Center for Reproductive Health, Nashville, TN, and other colleagues, including Claudia A. Steiner, M.D., of the Agency for Health Care Policy and Research, the national rate of total abdominal hysterectomies (TAHs) decreased from 25.7 per 10,000 women in 1991 to 20.5 in 1994. At the same time, the national rate of supracervical hysterectomies (SCHs) increased from 0.16 in 1991 to 0.41 in 1994. Although the rate of SCH has more than doubled, it is clear that the TAH technique continues to be dominant.

During the early 1990s, the merit of SCH was touted in the research literature and popular media. However, its superiority over TAH remains largely theoretical, and universal consensus is lacking. There is no indication that SCH is likely to overtake TAH as the preferred hysterectomy method for many years, note the researchers.

The average length of hospital stay and average hospital charges for both procedures tended to steadily decrease from 1991 to 1994. Total hospital charges for TAH in 1991 were $2.37 billion, which decreased to $2.27 billion by 1994. In contrast, total hospital charges for SCH essentially doubled from $23.6 million to $47.4 million during the same period, largely explained by the increased use of the procedure. In any case, the much lower use of SCH renders nominal its impact on national health care expenditures.

Standard criteria for performing both procedures are lacking. The question remains whether the small drift toward SCH was due to differences in the types of patients undergoing each procedure, changes in surgeon preference, or some other reason. More research is needed to explain these preliminary findings about changing hysterectomy patterns.

The findings are based on inpatient TAH and SCH discharges in the United States from 1991 to 1994 taken from the Health Care Cost and Utilization Project (HCUP) National Inpatient Sample. HCUP is an all payer, publicly available administrative data base, consisting of 6.5 million observations from approximately 950 hospitals. The data base, which includes charge data, allows national and regional estimates and can be used to study rare disease and infrequent procedures such as SCH.

More details are in "Abdominal hysterectomy practice patterns in the United States," by Dr. Sills, Jyot Saini, M.D., Dr. Steiner, and others, in the International Journal of Gynecology and Obstetrics 63, pp. 277-283, 1998. Reprints (AHCPR Publication No. 99-R053) are available from the AHCPR Publications Clearinghouse.

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