Regional and temporal variation in hysterectomy rates and surgical routes for benign diseases in the Netherlands

Objective. To provide descriptive statistics on hysterectomy for benign gynecological conditions in the Netherlands and to analyze regional and temporal variations in hysterectomy rates and surgical routes. Design. Retrospective cohort study. Setting. Dutch hospitals. Population. All women with a hysterectomy for benign gynecological conditions in the Netherlands in 19952005. Methods. This study is based on an analysis of the Dutch registry of hospital admissions for 19952005. Main outcome measures. The age-adjusted hysterectomy rate and age- and diagnosis-adjusted proportion of vaginal hysterectomies for each Dutch healthcare region and time period. Results. The average annual crude hysterectomy rate for benign disease only, was 17.2 per 10 similar to 000 women of all ages. The vaginal route was chosen for 50.8% of the patients. During the study period, the number of hysterectomies for bleeding disorders declined almost 25%. Among 27 Dutch healthcare regions, the age-adjusted hysterectomy rates for bleeding disorders and pelvic organ prolapse varied 2.2- and 2.3-fold, respectively. The average annual age- and diagnosis-adjusted proportion of vaginal hysterectomies varied from 43.4 to 63.8%. The regional differences with regard to rate and proportion declined slightly over time. Conclusions. The Netherlands is among the countries with the lowest hysterectomy rates and the highest proportion of vaginal hysterectomies. The regional differences indicate that a further decrease in the hysterectomy rates and an increase in the proportion of vaginal hysterectomies are possible