The appropriateness of recommendations for hysterectomy

Objective: To evaluate the appropriateness of recommendations for hysterect omies done for nonemergency and nononcologic indications. Methods: We assessed the appropriateness of recommendations for hysterectom y for 497 women who had the operation between August 1993 and July 1995 in one of nine capitated medical groups in Southern California. Appropriatenes s was assessed using two sets of criteria, the first developed by a multisp ecialty expert physician panel using the RAND/University of California-Los Angeles appropriateness method, and the second consisting of the ACOG crite ria sets for hysterectomies. The main outcome measure was the appropriatene ss of recommendation for hysterectomy, based on expert panel ratings and AC OG criteria sets. Results: The most common indications for hysterectomy were leiomyomata (60% of hysterectomies), pelvic relaxation (11%), pain (9%), and bleeding (8%). Three hundred sixty-seven (70%) of the hysterectomies did not meet the lev el of care recommended by the expert panel and were judged to be recommende d inappropriately. ACOG criteria sets were applicable to 71 women, and 54 ( 76%) did not meet ACOG criteria for hysterectomy. The most common reasons r ecommendations for hysterectomies considered inappropriate were lack of ade quate diagnostic evaluation and failure to try alternative treatments befor e hysterectomy. Conclusion: Hysterectomy is often recommended for indications judged inappr opriate. Patients and physicians should work together to ensure that proper diagnostic evaluation has been done and appropriate treatments considered before hysterectomy is recommended. (C) 2000 by The American College of Obs tetricians and Gynecologists.