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Study: Alternatives to hysterectomy may be underutilized

Alternatives to hysterectomy appear to be underused among women with abnormal uterine bleeding, uterine fibroids, endometriosis or pelvic pain, according to a recent study.

Researchers from the University of Michigan Health System and Wayne State University School of Medicine sought to assess whether specimen pathology supported the use of hysterectomy and to examine alternative treatment options offered to patients prior to surgery.

Daniel M. Morgan

From Jan. 1 through Nov. 8, 2013, Daniel M. Morgan, MD, and colleagues collected and analyzed perioperative hysterectomy data from 52 participating hospitals in the Michigan Surgical Quality Collaborative. The data included demographics, preoperative alternative treatments and pathology results. Women who had received a hysterectomy due to benign conditions, including uterine fibroids, abnormal uterine bleeding (AUB), endometriosis or pelvic pain, were eligible for participation. “Supportive” pathology was classified when there was presence of fibroids, endometriosis, endometrial hyperplasia, adenomyosis, adnexal pathology or unexpected cancer.

Of the 6,042 patients who underwent a hysterectomy, 56.2% (n = 3,397) met inclusion criteria. Among these patients, 37.7% had no documentation of alternative treatments, including hormonal therapy, pain management, levonorgestrel IUD, hysteroscopy and endometrial ablation, prior to surgery. However, researchers reported women aged younger than 40 years were more likely to consider alternative treatments compared with those aged 40 years and older (P<.001).

The highest rate of unsupportive pathology occurred in patients with endometriosis and chronic pain (40.4%); the lowest rate was seen in those with uterine fibroids or AUB (14.1%). Patients with a combination of the aforementioned indications had intermediate frequency (20.4%). Additionally, women aged younger than 40 years had a significantly higher rate of unsupportive pathology (37.8%) vs. those aged 40 to 50 years (12%) and those aged >50 years (7.5%; P<.001).

According to researchers, despite a decrease in the number of hysterectomies performed each year, there is still concern regarding appropriateness of the procedure.

“The fact that 18% of women did not have pathology supportive of the need for hysterectomy and that the majority of women consider at most one alternative treatment prior to hysterectomy indicates that there are opportunities to decrease the utilization of hysterectomy,” they wrote. “The levonorgestrel IUD, which is one of the most effective alternative treatments for AUB and pelvic pain, may be vastly underutilized. These are prime targets for quality improvement and cost savings by avoiding hysterectomy.”

Disclosures: DeLancey reports receiving research support from American Medical Systems, Johnson & Johnson, Kimberly Clark and Proctor and Gamble through the University of Michigan. The other authors report no relevant financial disclosures.