HYSTERECTOMY IN THE UNITED-STATES, 1988-1990

Objective: To describe patient characteristics and diagnoses associate d with hysterectomy in the United States from 1988-1990 using data fro m the National Hospital Discharge Survey. Methods: We analyzed data fr om the National Hospital Discharge Survey, an annual probability sampl e of discharges from nonfederal, short-stay hospitals in the United St ates. A population-based sample of all women aged 15 years or older in the United States civilian population who had a hysterectomy during 1 988-1990 was examined to characterize factors associated with hysterec tomy: patients' age and race, diagnoses, surgical approach, and oophor ectomy. Results: Approximately 1.7 million women had a hysterectomy du ring 1988-1990. The highest rates-100.5 hysterectomies per 10,000 wome n-were for women aged 30-54 years. Total rates of hysterectomy for bla ck women were similar to those for white women (61.7 and 56.5 per 10,0 00 women, respectively); uterine leiomyoma (''fibroid tumor'') was rep orted as the primary diagnosis for 61% of black women and 29% of white women. Abdominal surgery was used for 75% of all hysterectomies. Conc omitant bilateral oophorectomy was done for 37% of the women under 45 years old and 68% of the women 45 years or older. Conclusions: Two-thi rds of all hysterectomies for noncancerous conditions were performed f or uterine leiomyoma or endometriosis-conditions that are most common before the age of menopause. Future assessments of the appropriateness of hysterectomy will require better understanding of these disorders. Continued monitoring of hysterectomy rates is critical to understandi ng the appropriate use of hysterectomy, alternative therapies for uter ine disorders, and future trends in women's health care.