The effect of a second opinion program on hysterectomy performance

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.