Table 2.
Appropriateness Rating by Primary Indication for Hysterectomy Based on RAND Appropriateness Classification System and the Wright Appropriateness Algorithm in the Carolina Hysterectomy Cohort for 1,829 Noncancerous and Nonobstetric Hysterectomies Received Between October 2, 2014, and December 31, 2017, Among Patients Aged 18–44 Years
| Primary indications for surgerya | Total | RAND classification | Wright classification | |||
|---|---|---|---|---|---|---|
| Inappropriate | Appropriate | Inappropriate | Ambiguous | Appropriate | ||
| (N = 1256; 68.7%) | (N = 573; 31.3%) | (N = 479; 26.2%) | (N = 287; 15.7%) | (N = 1063; 58.1%) | ||
| %b | %b | %b | %b | %b | ||
| Uterine Leiomyomas | 683 | 59.3 | 40.7 | 32.2 | 20.2 | 47.6 |
| Menorrhagia | 638 | 95.1 | 4.9 | 28.0 | 39.5 | 32.5 |
| Abnormal Uterine Bleeding | 458 | 89.1 | 10.9 | 11.4 | 40.2 | 48.4 |
| Chronic Pelvic Pain | 416 | 91.3 | 8.7 | 31.5 | 14.9 | 53.6 |
| Dysmenorrhea | 322 | 78.3 | 21.7 | 40.7 | 7.1 | 52.2 |
| Endometriosis | 143 | 67.1 | 32.9 | 35.0 | 4.9 | 60.1 |
| Ovarian Cyst or Pelvic mass | 141 | 100.0 | 0.0 | 100.0 | 0.0 | 0.0 |
| Anemiac,d | 139 | 100.0 | 0.0 | 100.0 | 0.0 | 0.0 |
| Prolapse | 105 | 9.5 | 90.5 | 2.9 | 6.7 | 90.4 |
| Cervical Dysplasia | 75 | 77.3 | 22.7 | 24.0 | 52.0 | 24.0 |
| Incontinencec,d | 68 | 100.0 | 0.0 | 100.0 | 0.0 | 0.0 |
| Dyspareunia | 52 | 96.1 | 3.9 | 19.2 | 30.8 | 50.0 |
| Prophylactic for Cancer | 45 | 73.3 | 26.7 | 8.9 | 15.6 | 75.5 |
| Adenomyosis | 42 | 92.9 | 7.1 | 26.2 | 9.5 | 64.3 |
| Metrorrhagia | 41 | 95.1 | 4.9 | 9.8 | 41.5 | 48.7 |
| Endometrial Hyperplasia | 38 | 65.8 | 34.2 | 44.7 | 0.0 | 55.3 |
| Bulk Symptomsc,d | 35 | 100.0 | 0.0 | 100.0 | 0.0 | 0.0 |
| Gender Affirming Carec | 35 | 100.0 | 0.0 | 34.3 | 11.4 | 54.3 |
| Other Pain | 27 | 88.9 | 11.1 | 18.5 | 29.6 | 51.9 |
| Post-Ablation Tubal Sterilization Syndromec | 19 | 100.0 | 0.0 | 0.0 | 0.0 | 100.0 |
| Polypsd | 14 | 92.9 | 7.1 | 7.1 | 0.0 | 92.9 |
| Structural Abnormalitiesd | 11 | 100.0 | 0.0 | 100.0 | 0.0 | 0.0 |
| Failed Medical Managementc | 10 | 100.0 | 0.0 | 100.0 | 0.0 | 0.0 |
| Infection (PID, TOA) | 8 | 62.5 | 37.5 | 62.5 | 0.0 | 37.5 |
| Polycystic Ovarian Syndromec,d | 8 | 100.0 | 0.0 | 100.0 | 0.0 | 0.0 |
| Infertilityc,d | 7 | 100.0 | 0.0 | 100.0 | 0.0 | 0.0 |
| Premenstrual Syndrome/Premenstrual Dysphoric Disorder | 6 | 100.0 | 0.0 | 83.3 | 0.0 | 16.7 |
| Low Grade Cervical Dysplasia | 5 | 80.0 | 20.0 | 40.0 | 40.0 | 20.0 |
| Sterilizationd | e | 100.0 | 0.0 | 100.0 | 0.0 | 0.0 |
| Otherf | e | 100.0 | 0.0 | 100.0 | 0.0 | 0.0 |
| No Primary Indication | 83 | 100.0 | 0.0 | 100.0 | 0.0 | 0.0 |
a
Primary indications for surgery are not mutually exclusive.
b
Row percent.
c
Primary indications for surgery not described in RAND.
d
Primary indications for surgery never the lone primary indication.
e
Table cells with sample sizes <5 have been suppressed.
f
Muscle spasm and female genital organ symptoms.