> ----- Original Message -----
From: Helen Dynda
To: Multiple recipients of list ADHESIONS
Sent: Tuesday, November 05, 2002 6:28 PM
Subject: Hysterectomy or an Alternative?
Hysterectomy or an Alternative?
http://www.hosppract.com/issues/2000/09/shoupe.htm
" Even though hysterectomy remains an appealing solution for a number of nonmalignant gynecologic conditions, patients are often scheduled for surgery without proper evaluation or consideration of an alternative. For symptoms associated with uterine fibroids or endometriosis, there are alternative treatments that cause less morbidity, are less costly, and often are equally effective. Conservative management may also be appropriate for selected patients with early gynecologic cancer.
" More than 500,000 hysterectomies are performed annually in the United States. While this represents a significant drop from the peak incidence reported 25 years ago, the current rate of 5.5 per year per 1,000 women is still the highest among countries with published data. By contrast, Sweden's hysterectomy rate is less than two per 1,000 women.
" In the United States, almost 40% of women have had a hysterectomy by age 65. The vast majority of these are performed for nonlife-threatening indications such as uterine fibroids (33.4%), endometriosis (18.9%), and uterine prolapse (16.4%). Only about 10% are performed for cancer. This has led both researchers and the general public to question the rationale for removing a healthy, functioning organ (or organs if the ovaries are removed at the same time) and exposing patients to excessive morbidity and mortality when more conservative management may be equally effective. The familiarity of the surgical procedure, the lack of experience of many physicians with newer treatment methods (e.g., endometrial ablation for control of bleeding), the absence of definitive data comparing patient outcomes, and the fact that reimbursement tends to be lower for medical management perpetuate a situation in which normal standards for determining the appropriateness of a treatment are overlooked. Indeed, patients are scheduled for hysterectomy without proper evaluation or consideration of reasonable alternatives."
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