• S Haas, D Acker, C Donahue, and M E Katz.
• Department of Obstetrics and Gynecology, Brigham and Women's Hospital Harvard Medical School, Boston, MA 02115.
• Am. J. Obstet. Gynecol. 1993 Jul 1;169(1):150-4.

ObjectiveOur objective was to determine whether small-area variation in hysterectomy rates exists within Massachusetts and, if so, whether regions with persistently high or low rates can be identified.Study DesignBy examining data derived from standardized hospital discharge forms between 1982 and 1989, we compared hysterectomy rates among 172 small geographic areas within Massachusetts. The ratios of actual to expected number of hysterectomies for each area were also computed. Statistical significance of rate variation was established by a value of p < 0.01 (chi 3 test).ResultsThe-hysterectomy rate per 1000 women varies fivefold across small-population areas of Massachusetts. Eight areas had persistently high and five had persistently low rates compared with the statewide average.ConclusionPossible explanations for these rate variations include indigenous population factors, supply of health care resources, income, insurance coverage, methodological problems in data analysis, and variation in professional judgment with regard to the indication for hysterectomy. Only a combination of the study of local causes of high and low rates and the study of the clinical outcomes of different treatment decisions will allow physicians to develop an informed consensus on appropriate indications for surgery.

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