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 1995-2005. METHODS: This study is based on an analysis of the Dutch registry of hospital admissions for 1995-2005. 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 10,000 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.