Persistent high rates of hysterectomy in Western Australia: a population-based study of 83 000 procedures over 23 years


Dr K Spilsbury, Centre for Health Services Research, School of Population Health, M431, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia 6009, Australia. Email


Objective  To investigate incidence trends and demographic, social and health factors associated with the rate of hysterectomy and morbidity outcomes in Western Australia and compare these with international studies.

Design  Population-based retrospective cohort study.

Setting  All hospitals in Western Australia where hysterectomies were performed from 1981 to 2003.

Population  All women aged 20 years or older who underwent a hysterectomy.

Methods  Statistical analysis of record-linked administrative health data.

Main outcome measures  Rates, rate ratios and odds ratios for incidence measures and length of stay in hospital and odds ratios for morbidity measures.

Results  The age-standardised rate of hysterectomy adjusted for the underlying prevalence of hysterectomy decreased 23% from 6.6 per 1000 woman-years (95% CI 6.4–6.9) in 1981 to 4.8 per 1000 woman-years (95% CI 4.6–4.9) in 2003. Lifetime risk of hysterectomy was estimated as 35%. In 2003, 40% of hysterectomies were abdominal. The rate of hysterectomy to treat menstrual disorders fell from 4 per 1000 woman-years in 1981 to 1 per 1000 woman-years in 1993 and has since stabilised. Low socio-economic status, having only public health insurance, nonindigenous status and living in rural or remote areas were associated with increased risk of having a hysterectomy for menstrual disorders. Indigenous women had higher rates of hysterectomy to treat gynaecological cancers compared with nonindigenous women, particularly in rural areas. The odds of a serious complication were 20% lower for vaginal hysterectomies compared with abdominal procedures.

Conclusion  Western Australia has one of the highest hysterectomy rates in the world, although proportionally, significantly fewer abdominal hysterectomies are performed than in most countries.