Variation in gynaecological procedure suggests surgery is unnecessary

November 22, 2002

The most common minor surgical procedure in gynaecological practice may be performed unnecessarily, as evidenced by the large variation across regions, says a University of Alberta researcher.

In a paper published in the current edition of the Journal of Obstetrics and Gynaecology Canada, Dr. David Cumming investigates the rates of dilation and curretage (D&C) for abnormal bleeding and following pregnancy in regions across Alberta.

He and his research team examined D&C in 1.3 million women in 17 sites across Alberta. They found that in some regions, a woman may be five times more likely to have the procedure done as in another region. Although D&C is generally safe, it is a surgical procedure and carries a complication rate.

The literature suggests that D&C is unnecessary and that other simpler less invasive therapy can accomplish what D&C is supposed to do. As well as being more invasive, performing a D&C is much more expensive, Cumming found. The bill for an outpatient hospital D&C was approximately $330 to $433. By contrast, over the same time period, office biopsy in Alberta can cost $32.48. Using estimates from the study, D&C procedures described in this study would cost approximately $3 to $4 million.

The economic reason is a "good incentive to reexamine the role of and the need for D&C, a procedure that may be 'virtually obsolete,'" said Cummings, in the study.

Increasing physician awareness of less invasive options for the management of abnormal uterine bleeding and early pregnancy loss is key, said Cumming.
The U of A in Edmonton, Alberta is one of Canada's premier teaching and research universities serving more than 30,000 students with 6,000 faculty and staff. It continues to lead the country with the most 3M Teaching Fellows, Canada's only national award recognizing teaching excellence.

University of Alberta

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