Washington State Hysterectomy Rates: Variations and
Policy Implications

By Sara Vaezy, Department of Health Services

Sara Vaezy

Approximately 600,000 hysterectomies are performed in the United States annually, making hysterectomy the second-most commonly performed procedure in the country. Variations in hysterectomy rates from one geographic region to another have led to questions about both the appropriateness of the procedure and possible overuse or misuse.

Evidence suggests that uncertainty among healthcare professionals about the appropriate use of hysterectomy is the primary cause of the variation in rates. There are five conditions for which hysterectomy is commonly indicated: cancer, endometriosis, genital prolapse, leiomyoma, and uterine bleeding. While the indication for hysterectomy with a cancer diagnosis is clear, medical opinion is divided on the appropriate course of treatment for patients with endometriosis, genital prolapse, leiomyoma, or uterine bleeding. For diagnoses in which the indication is not clear-cut, patient preferences also factor into the decision-making process.

The aim of my MPH research (under the direction of Cindy Watts and Will Welton) was to see how hysterectomy rates varied throughout the state of Washington; in particular, the study focused on the relationship between the reason for the hysterectomy and the degree of variation.

The study, conducted with the Strategic Health Planning Office in the state’s Office of Financial Management, showed that regional hysterectomy rates for women with a cancer diagnosis had the smallest variation, while hysterectomy rates after a diagnosis of menstrual hemorrhage had the greatest variation. For all diagnoses except cancer, statistical analysis showed significant differences between regional data and the state average. Patterns in variation were also observed: more remote or rural regions appear to have higher hysterectomy rates than urban regions, such as King County.

This study highlighted the need for several actions to be undertaken by Washington state policymakers. First, initiatives to strengthen state data systems are critical if we are to accurately measure and identify variations in hysterectomy rates—and, indeed for other services as well. Second, it is important to create partnerships with physicians for education and performance feedback. Third, implementing patient education and shared decision-making pilot programs will involve patients in their own care.

And finally, collaboration between public and private payers can help develop payment guidelines for hysterectomies.