Decreasing utilization of hysterectomy: a population-based study in Olmsted County, Minnesota, 1965-2002

Abstract

Objective: The purpose of this study was to assess temporal trends for hysterectomy among Olmsted County, Minnesota women.

Study design: Using the Rochester Epidemiology Project database, we identified all county residents undergoing a hysterectomy in 1965-2002. Temporal changes in the utilization (incidence) rate, type, diagnostic indications, and age at surgery were assessed.

Results: Between 1965 and 2002, 6152 women had a hysterectomy alone, whereas 3126 women had, in addition, a pelvic floor repair; the age-adjusted utilization rate for hysterectomy alone and for combined procedures declined (P < .0001) by 13% and 63%, respectively. Except for subjects aged 75-85 years, this decline affected every age group. The distribution of vaginal (56%) and abdominal (44%) procedures differed across indications. Uterine leiomyomata, precancerous conditions, and genital prolapse accounted for 28%, 23%, and 12% of all procedures, respectively.

Conclusion: Among community women, the utilization rate, age distribution, and indications for a hysterectomy changed substantially between 1965 and 2002.

Figures

FIGURE. Odds ratio (95% CIs) for abdominal versus vaginal hysterectomy among Olmsted County, MN

Women A, aged ≤ 50 years B, and > 50 years. The reference group is women ≤ 50 years who had a hysterectomy for uterine leiomyoma between 1965-1974. In women aged ≤ 50 years, endometriosis and inflammatory conditions were associated with increased odds, while uterine prolapse or menstrual or menopausal disorders were associated with lower odds for abdominal hysterectomy relative to the reference group. The most striking age-related difference was that older women undergoing a hysterectomy for cancer or for debulking were more likely than younger women to have an abdominal hysterectomy. Between 1965-2002, the utilization rate for hysterectomy in the population declined by 37%; the age distribution and indications for this procedure also changed over time.