Insight
June 26, 2020

Hysterectomy overuse on the Lown Index

Some hospitals are performing a large number of unnecessary hysterectomies. Here's why that's important.

By Judith Garber

Key Takeaways

  • According to the Lown Index, hysterectomy (surgical removal of the uterus) is frequently overused for benign conditions. For 81 percent of hospitals, at least half of all hysterectomies performed between 2015 and 2017 were unnecessary. 1,167 hospitals performed at least 20 unnecessary hysterectomies between 2015 and 2017, and 495 hospitals performed at least 50.
  • Previous research finds that overuse of hysterectomy disproportionately affects Black women, who are more likely than white women to have a hysterectomy for a benign condition.
  • Policymakers and patients should question why certain regions of the country have much higher rates of unnecessary hysterectomy and whether these rates are influenced by implicit racial biases.

Annually, about 600,000 hysterectomies are performed in the United States. It is estimated that 45 percent of women in the country will have a hysterectomy in their lifetime. This rate is even higher for Black women, who are 2.5 times more likely

Only about 10 percent of hysterectomies are performed due to a cancer diagnosis; the other 90 percent are done as treatment for non-cancerous (benign) conditions such as uterine fibroids-- growths in the uterus that can lead to heavy menstrual bleeding and pelvic pain. In most cases, fibroids disappear after menopause.

Black women are 2.5 times more likely to have a hysterectomy than White women."

For benign conditions such as fibroids, there are many alternative treatments to hysterectomy, such as removing just the fibroids, taking oral contraceptives or other medications, or (if the fibroids are not too painful or bothersome) waiting for them to go away on their own. Yet doctors may recommend hysterectomy as a first line of treatment for fibroids, especially when the patient is above childbearing age, the assumption being that after menopause, the uterus is “useless.” 

In fact, the uterus and ovaries work together to regulate hormones over a woman’s lifetime. Even after menopause, the uterus helps to anchor other pelvic organs within the body. Removing the uterus can lead to bladder and bowel dysfunction, incontinence, mood swings, sexual dysfunction, back and hip problems, and chronic pain. And of course, removing the uterus ends the possibility of childbearing.

495 hospitals performed at least 50 unnecessary hysterectomies each between 2015 and 2017."

As part of the Lown Institute Hospitals Index, we ranked hospitals on their use of 13 common low-value services, one of which was unnecessary hysterectomy. Hospitals were ranked on avoiding hysterectomies based on the percentage of hysterectomies that were unnecessary and adjusted for the total volume of hysterectomies performed. For example, when two hospitals had the same rate of unnecessary hysterectomies, the hospital with larger volume received a score indicating more overuse.  

Our analysis confirms that this procedure was commonly overused in U.S. hospitals; 1,167 hospitals performed at least 20 unnecessary hysterectomies and 495 hospitals performed at least 50. For 81 percent of hospitals, at least half of all hysterectomies performed between 2015 and 2017 were unnecessary. 

There were 889 hospitals that did not perform any unnecessary hysterectomies, but 883 of these hospitals did not have the capacity to perform the procedure in the first place. Only 6 hospitals in the U.S. that could have done unnecessary hysterectomies completely refrained from doing so over the course of three years.   

Among the hospitals that had the most hysterectomy overuse (see Table 1), a majority were nonprofit, large, urban teaching hospitals. However, there are many exceptions; the lowest ranked hospital in the nation for performing hysterectomies unnecessarily (meaning the most overuse) is a for-profit women’s hospital in Texas and the second-lowest is a rural nonprofit hospital in Mississippi. Fifteen of the 20 hospitals with the lowest Lown Index rankings on avoiding hysterectomy are in the South.

Table 1: Worst hospitals for hysterectomy overuse

Hospital name State Hospital type Number of hysterectomies for benign disease Number of total hysterectomies Percent unnecessary hysterectomies
The Womans Hospital of Texas TX For-Profit, urban, large, teaching 197 213 92%
North Mississippi Medical Center  MS Nonprofit, rural, very large, teaching 149 154 97%
Jackson-Madison County General Hospital TN Nonprofit, urban, very large, teaching 139 142 98%
Baptist Health Medical Center-Little Rock  AR Nonprofit, urban, very large, teaching  156 165 95%
Scottsdale Shea Medical Center  AZ Nonprofit, urban, very large, teaching 209 238 88%
Candler Hospital  GA Nonprofit, urban, large, non-teaching 181 202 90%
Medstar Washington Medical Center DC Nonprofit, urban, very large, teaching 181 203 89%
Christus Mother Frances Hospital  TX Nonprofit, urban, very large, non-teaching 120 123 98%
Loma Linda University Medical Center  CA Nonprofit, urban, very large, teaching  139 149 93%
Mercy Hospital St Louis  MO Nonprofit, urban, very large, teaching 244 288 85%
Emory University Hospital  GA Nonprofit, urban, very large, teaching 107 108 99%
Sanford Medical Center Fargo  ND Nonprofit, urban, very large, teaching 113 116 97%
Forrest General Hospital  MS Nonprofit, urban, very large, teaching 106 109 97%
Cookeville Regional Medical Center  TN Nonprofit, rural, large, non-teaching 102 104 98%
Owensboro Health Regional Hospital  KY Nonprofit, urban, large, teaching 98 99 99%
Anne Arundel Medical Center  MD Nonprofit, urban, very large, teaching 206 241 85%
Essentia Health Duluth  MN Nonprofit, urban, medium, teaching 105 109 96%
Christus Spohn Hospital Corpus Christi  TX Nonprofit, urban, very large, teaching 92 92 100%
Tampa General Hospital FL Nonprofit, urban, very large, teaching 106 111 95%
Naples Community Hospital FL Nonprofit, urban, very large, non-teaching 99 102 97

Comparing hospitals in different regions, hospitals in the Northeast are in the highest percentile rank (meaning they were least likely to perform unnecessary hysterectomies) on average (55 percent) and hospitals in the South are in the lowest (45 percent). When you look at the rankings on hysterectomy by state, the differences become starker (see Figure 1). Most states in the Northeast and West Coast (and some states in the Midwest) rank in the 50-60th percentile on average for avoiding unnecessary hysterectomy, while states in the South and West perform comparatively worse.