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.

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.

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.

Hysterectomy overuse on the Lown Index

Key Takeaways

What do the top hospitals on the Lown Index have in common?

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