Concept: Hysterectomy

Definition of Hysterectomy

A hysterectomy is a surgical operation to remove the uterus and, sometimes, the cervix. Removal of the body of the uterus without removing the cervix is referred to as a subtotal hysterectomy. Removal of the entire uterus and the cervix is referred to as a total hysterectomy. See MedlinePlus® - Health Topics - Hysterectomy for more information.

Definition in Administrative Data

Hysterectomies have been defined using administrative data at MCHP in a number of studies. There have been small modifications for each project for various reasons.

1. Roos et al. (1989)

In Roos et al. (1989) Manitoba Health Services Commission tariff codes were used in conjunction with hysterectomy procedure codes in the hospital discharge abstracts data to determine the correspondence between billed for procedures in medical services/physician claims and procedures coded in the abstracts. These tariff codes included:


• 4586 - Laparotomy with biopsies to determine chemotherapy response for carcinoma of ovary - with hysterectomy
  
• 4617 - Hysterectomy, total, with or without adnexal surgery
  
• 4621 - Hysterectomy, sub-total, with or without adnexal surgery
  
• 4627 - Hysterectomy, radical, with pelvic lymphadenectomy
  
• 4631 - Vaginal hysterectomy, with or without complete repair
  
• 4699 - Unlisted or unusually complicated female genital system, abdominal operations

2. HEALNET Study (1996), Gentlemen et al. (1996) and Ross & Mustard (1997)

The 1996 HEALNET Study at MCHP used the following ICD-9-CM procedure codes when identifying hysterectomies:


• 68.3 - Subtotal abdominal
  
• 68.4 - Total abdominal
  
• 68.5 - Vaginal
  
• 68.6 - Radical abdominal
  
• 68.7 - Radical vaginal
  
• 68.8 - Pelvic evisceration

In Gentleman et al., 1996 hysterectomies were defined using ICD-9-CM codes 68.3-68.7. Gentlemen et al. classified procedures into "primarily discretionary", "intermediate", and "primarily non-discretionary". These procedures, including hysterectomies, can be seen in the SAS label file $vaydal.

In Roos and Mustard, (1997) hysterectomies were defined using ICD-9-CM codes 68.4 and 68.5.

3. Martens et al. (2002 & 2003) and Fransoo et al. (2005)

In the deliverables The Health and Health Care Use of Registered First Nations People Living in Manitoba: A Population-Based Study by Martens et al. (2002), The Manitoba RHA Indicators Atlas: Population-Based Comparison of Health and Health Care Use by Martens et al. (2003) and Sex Differences in Health Status, Health Care Use, and Quality of Care: A Population-Based Analysis for Manitoba's Regional Health Authorities by Fransoo et al. (2005) hysterectomy definitions were limited to those age 25 and older having one of the following ICD-9-CM codes recorded in any of the procedure fields in the hospital discharge abstract:


• 68.4 Total abdominal hysterectomy (includes "other and unspecified hysterectomy" for 1992/93 and earlier)
  
• 68.5 Vaginal hysterectomy
  
• 68.9 Other & unspecified hysterectomy (1993/94 & onward)

Modifications have been made to this definition based on work done at CIHI (2004) & CDC (2002). These studies included some additional codes but excluded hysterectomies done when there is a co-morbid condition indicating some cancers, HIV, and/or some trauma. The 2004/05 NTK deliverable Sex Differences in Health Status, Health Care Use, and Outcomes of Care: A Population-Based Study for Manitoba's Regional Health Authorities adopted these exclusions. It was found that these conditions are associated with between 2 and 5% of the hysterectomies done in Manitoba between 1984/05 and 2003/04. This deliverable looked at hysterectomies done between 1984/85 and 2002/03 for a cohort of females aged 54 in 2002/03 with continuous coverage. This age was used due to data limitations (easy) we have coverage and hospital claims with identifiers added from 1984/85. The Age range 35-54 contains 64.5% of all of the hysterectomies done in any individual year.

The CIHI Definition for hysterectomies when looking at readmissions: ICD-9-CM 684-687, 689 (note ICD-10-CA/CCI codes CCI codes of 1.RM.89, 1.RM.91, 5.CA.89.WJ, 5.CA.89.CK, 5.CA.89.GB and not a status attribute of "A" (abandoned procedure)).

Ages: 15-84


Exclusions:

• Discharge as death or self signout
  
• Cancer (ICD-9 or ICD-9-CM 140-172, 174-208, V58.1, V58.0 or ICD-10 C00-C26, C30-C44, C46-C96, Z51.0, Z51.1, Z51.2)
  
• HIV (ICD-9 or ICD-9-CM 042, 043, 044, V08 or ICD-10 B24, Z21, R75)
  
• Trauma (ICD-9 or ICD-9-CM E800-848, E881-8841, E8849, E8860, E890-899, E900-910, E913-926, E928, E950-968, E970-976, E990-998 or ICD-10 V01-V99, W00-W23, X00-X09, W92-W94, X17, X30, X31, X51, X53, X54, X57, X20-X29, W53-W60, X33-X38, W30, W31, W44, W45, W64-W84, W50-W52, W25-W27, W33-W40, W85-W99, X10-X19, X60-X84, X85-Y09, Y04, Y05, Y35, Y36

4. Martens et al. (2008)

In the deliverable What Works? A First Look at Evaluating Manitoba's Regional Health Programs and Policies at the Population Level by (Martens et al. (2008) , hysterectomies were defined using ICD-9-CM procedure codes 68.4, 68.5, or 68.9 in hospital discharge abstracts data.

Note: this definition excludes procedure codes for radical hysterectomies (ICD-9-CM codes 68.6 and 68.7) typically associated with cancer cases.

5. Martens et al. (2010) and Chartier et al. (2012)

In the deliverables Profile of Metis Health Status and Healthcare Utilization in Manitoba: A Population-Based Study by Martens et al. (2010) and Health and Healthcare Utilization of Francophones in Manitoba by Chartier et al. (2012) hysterectomy surgeries were defined from the hospital discharge abstracts data using:


• ICD-9-CM procedure codes 68.4, 68.5, or 68.9, OR
  
• CCI codes 1.RM.89, 5.CA.89.CK, 5.CA.89.DA, 5.CA.89.GB, 5.CA.89.WJ, or 5.CA.89.WK

NOTE: This definition was restricted to all Manitoba female residents aged 25 and older.

UPDATE:

We received a communication from Manitoba Health in December, 2017 and after review, need to update our working definition of hysterectomy.

The code 5.CA.89, surgical termination of pregnancy, should be included in our list of codes for hysterectomy, but only the following codes: 5.CA.89.GB, 5.CA.89.WJ and 5.CA.89.CK, as described in the list below. Note that two codes previously used in our research definition, 5.CA.89.DA and 5.CA.89.WK, identify a hysterotomy procedure (incision of the uterus, not removal of the uterus), so they should not be included in the definition. During our review, we found that both hysterotomy codes were coded only once in the Metis deliverable and not at all in the Francophone deliverable. This rare occurrence will not change the overall rates of hysterectomy from a population perspective, therefore no errata will be produced for these reports.

Additional hysterectomy codes have been added to the definition. In future research, the following CCI codes should be used in a definition of hysterectomy surgical cases performed in a hospital:



• 1.RM.87 – Excision partial, uterus and surrounding structures, but only with extent attribute = ‘SU’ (subtotal hysterectomy)
  
• 1.RM.89 – Excision total, uterus and surrounding structures
  
• 1.RM.91 – Excision radical, uterus and surrounding structures
  
• 5.CA.89.GB – Surgical termination of pregnancy with hysterectomy (endoscopic approach)
  
• 5.CA.89.WJ – Surgical termination of pregnancy with hysterectomy (open approach)
  
• 5.CA.89.CK – Surgical termination of pregnancy with hysterectomy (vaginal approach)
  
• 5.MD.60.RC – Cesarean section delivery with hysterectomy (with use of forceps)
  
• 5.MD.60.RD – Cesarean section delivery with hysterectomy (with use of vacuum)
  
• 5.MD.60.KE – Cesarean section delivery with hysterectomy (without instrumentation)
  
• 5.MD.60.CB – Cesarean section delivery with hysterectomy (with use of both vacuum and forceps)

More Information

• ICD-9-CM manual effective October 1, 1995 in the US; effective April 1, 1996 in Canada.
  
  
• CCP labels from CCP manual, Statistics Canada, Health Division, Nosology Reference Centre. June, 1986.
  
  
• Tariff Labels from Manitoba Health Physicians Manual (1995)
  
  
• Canadian Institute for Health Information (CIHI), Health Indicators June 2004 Catalogue no. 82-221-XIE, Volume 2004, No. 1 Technical Note Hysterectomy Readmission Rate. [website]
  
  
• Keshavarz H, Hillis S, Kieke B & Marchbanks P(2002) Hysterectomy Surveillance --- United States, 1994--1999. CDC Surveillance Summaries July 12, 2002 / 51(SS05);1-8.
  
  
• Canadian Institute for Health Information (CIHI), Canadian Classification of Health Interventions, Volume Three - Tabular List, 2015.