Recommendations of Hysterectomy Criticized

A UCLA/Rand Corp. study has found that 70% of doctors’ decisions to recommend hysterectomies were arrived at inappropriately, often without adequate information or consideration of alternative treatments.

In many of the cases, hysterectomy may have been the correct procedure but was undertaken without following proper diagnostic or therapeutic steps.

The internal examinations known as laporoscopies or laporotomies were not performed on 77% of women with pelvic pain to determine the cause for the pain. One-fifth of women with pain or bleeding did not receive alternative medical treatment, such as medication.

“In lots of those cases [the hysterectomy was] appropriate, but the quality of the work-up and evaluation were not appropriate,” said Dr. Michael S. Broder, lead author of the study and an assistant professor at UCLA Medical School.

But 14% of the 497 hysterectomy recommendations at nine Southern California medical groups were deemed clearly inappropriate given the symptoms, a finding consistent with previous studies.

The appropriateness of doctors’ decision-making was judged by an expert physician panel and was also evaluated according to the official criteria of the American College of Obstetricians and Gynecologists.

The findings are the latest in a long-standing debate over the frequency of hysterectomies, performed on about 560,000 women annually in the United States. The most common cause is fibroids, which can cause pain and bleeding.

Critics say that hysterectomies have been done far too readily, according to Bernadine Healy, former director of the National Institutes of Health.

“I’m not at all surprised” by the research, said Dr. Ivan Strausz, an obstetrician-gynecologist at Metropolitan Hospital Center in New York and author of “You Don’t Need a Hysterectomy.” Evaluating the alternatives “all takes time and modern medicine is increasingly a rapidly delivered business.”