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© 1996 Faculty of Public Health Medicine of the Royal Colleges of Physicians of the United Kingdom

research-article

Regional variations in the utilization rate of vaginal and abdominal hysterectomies in the United Kingdom


Clive Mulholland, Research Fellow
Nancy Harding, Lecturer
Suzanne Bradley, Research Assistant
Mike Stevenson, Research Fellow

Health and Health Care Research Unit, The Queens University of Belfast, Mulhouse Building, Institute of Clinical Science Grosvenor Road, Belfast BT12 6BJ
Institute of Health Care Studies, University of Wales Singleton Park, Swansea SA2 8PP
Health and Health Care Research Unit, The Queens University of Belfast


Address correspondence to Dr C. Mulholland

BACKGROUND: Large geographic variations in hysterectomy rates are well known; however, very little is known about geographic variations in the route of the procedure, i.e.whether it is performed abdominally or vaginally. We compared utilization rates for abdominal and vaginal hysterectomies for the 14 Regional Health Authorities of England, and Northern Ireland over a three-year period.

METHODS: Data were collected in the form of hospital episode statistics and small area analysis techniques were used to document regional variations.

RESULTS: Large regional differences in the utilization of vaginal hysterectomies were recorded. Three areas in particular (Northern Ireland, Yorkshire and NW Thames)displayed high vaginal to abdominal ratios. Northern Ireland recorded the highest ratio (0•366), Mersey Regional Health Authority the lowest (0•139). The use of the vaginal route was found to increase with age, and was the most common route for the >65 years age group.

CONCLUSION: Despite an increasing volume of evidence advocating the use of the vaginal route, there appears to be a resistance to its use, except in older women. The role of physician practice style, and in particular group clinical judgement, is highlighted as being significantly involved in explaining the observed geographic variations.

Keywords: hysterectomy, abdominal, vaginal, utilization


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