Persistent High Rates of Hysterectomy in Western Australia: A Population-Based Study of 83,000 Procedures Over 23 Years

Abstract

Hysterectomy is one of the most common surgeries performed on women living in Western countries, but rates differ substantially both between and within countries. This population-based retrospective cohort study examined trends in the incidence rate of hysterectomy in Western Australia, which has one of the highest rates in the world and one similar to that reported for the United States. Rates were followed over a 23-year period from 1981 to 2003, during which time 83,068 hysterectomies were done in women 20 years of age and older. The average age at the time of hysterectomy increased from 41.7 years in 1981 to 48.0 years in 2003. The rate of hysterectomy declined 23% during this time. By 2003, the age-standardized rate, adjusted for the prevalence of hysterectomy in the community, was 4.8 per 1000 women. The rate of abdominal hysterectomy decreased by an average of 3.7% each year from 1981 to 2003, whereas at the same time, the rate of vaginal hysterectomy (VH) increased by an average of 1.4% annually. Since it was introduced in the early 1990s, the rate of laparoscopically-assisted VH (LAVH) has increased by an average of 13.3% a year. By 2003, VH accounted for 45% of all hysterectomies, abdominal hysterectomy for 40%, and LAVH for 15%. A decline in hysterectomies done for menstrual disorders was partially offset by an increase in hysterectomy as a treatment for fibroids. Hysterectomy for menstrual disorders was done significantly more often in women living in rural and remote areas. Regardless of site of residence, indigenous women had half the overall rates of hysterectomy than did nonindigenous women. Nevertheless, the rate of surgery for gynecologic cancer was higher in indigenous women. The rate of serious procedure-related problems was 2.2%, and approximately 20% fewer such events occurred in women having VH rather than abdominal hysterectomy. During the period under study, the average hospital stay for hysterectomy decreased from 11.5 to 5.0 days. Although Western Australia still has a relatively high rate of hysterectomy, significantly fewer abdominal procedures are done than in most other countries.