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Key words hospital separation records, hospital utilization, length of stay, surgical rates, women's health
In Canada, the hysterectomy rate per 100,000 women aged 35 or older has declined sharply since the early 1980s. To some degree, this may be attributable to the development of alternatives in the treatment of gynecological problems.(1)(2)(3)(4)(5) As well, women's desire for less aggressive means of treatment may have produced a shift toward more careful patient screening and outpatient management of conditions that at one time might have resulted in a hysterectomy.(6)(7)
While the hysterectomy rate fell in each province, interprovincial variations remained substantial. Regional differences in hysterectomy rates are not unique to Canada; they have been noted in the United States,(8)(9)(10)(11)(12)(13) Britain(14) and Australia.(15) Such geographic variations cannot be attributed solely to differences in age distribution or in the incidence or risk of uterine disease.(12)(16) The primarily elective nature of hysterectomy suggests that other factors may be involved.
Rates of surgery will tend to vary when the indications for a specific procedure are discretionary.(17) This is the case with hysterectomies, an estimated 90% of which are elective.(8) Unlike many other surgical procedures, hysterectomies are performed for a wide range of indications. Malignant and pre-malignant conditions account for only a small proportion of hysterectomies. Most often, they are done to relieve symptoms caused by benign conditions: fibroids, dysfunctional uterine bleeding, endometriosis, chronic pain, and genital prolapse.(7)(8)(12)(25)(26)(27)(28)(29)
The appropriate indications for hysterectomy remain controversial, even among health care professionals.(8)(29) Moreover, there is real difficulty in diagnosing some of the conditions for which hysterectomy is commonly performed.(6) Concern that some hysterectomies may be unnecessary has long been expressed, not only by patients and policymakers, but also by physicians.(27)
This article analyzes national and provincial trends in hysterectomy among women aged 35 or older during the 16-year period from...