Finkel M L, Finkel D J
Cornell University Medical College, Department of Public Health, New York, NY 10021.
Med Care. 1990 Sep;28(9):776-83. doi: 10.1097/00005650-199009000-00007.
Large regional variations in hysterectomy rates cannot be explained by gynecologic need alone, giving rise to concerns about unnecessary surgery. This study's population consists of women insured through a major insurance carrier in 1987 who were required to obtain a second opinion for an elective hysterectomy. Of the 1,698 women referred for a second opinion for a proposed hysterectomy, 135 (8.0%) were not confirmed for the surgery and a random sample of these women were selected for this study. While confirmation rates did not vary significantly among regions, surgical rates did. Women in the Northeast tended NOT to have surgery when not confirmed; women in the South and North Central regions who were not confirmed tended to have surgery. Among these women, some hysterectomies were performed for questionable reasons, i.e., symptoms did not warrant surgical intervention, no pathologic justification, or conservative treatment preferable.
子宫切除术发生率在地区间存在很大差异，这不能仅用妇科需求来解释，由此引发了对不必要手术的担忧。本研究的对象是1987年通过一家主要保险公司投保的女性，她们在接受选择性子宫切除术时需要获得第二种意见。在1698名因拟行子宫切除术而被转介寻求第二种意见的女性中，有135名（8.0%）未被确认需要进行手术，本研究从中随机抽取了这些女性作为样本。虽然确认率在各地区之间没有显著差异，但手术率却有所不同。东北部未被确认需要手术的女性往往不接受手术；南部和中北部未被确认需要手术的女性则往往接受手术。在这些女性中，有些子宫切除术的实施理由存疑，即症状并不需要手术干预、没有病理依据或保守治疗更为可取。
