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Hysterectomy on benign indications in Sweden 1987-2003: a nationwide trend analysis
Cecilia Lundholm1, Catharina Forsgren, Anna L V Johansson
1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Objective:
To investigate the annual rates, types and indications for hysterectomy on benign indications in Sweden 1987-2003.
Design:
A nationwide register-based cohort study.
Setting:
The Swedish Inpatient Register.
Population:
All women hysterectomized for benign disease in Sweden from 1987 through 2003 (n=121,947).
Main Outcome Measure:
Hysterectomy on benign indications calculated as proportions or rates/100,000 person-years.
Results:
From 1987 to 1999, the annual overall hysterectomy rate increased from 178 to 232/100,000 person-years. Thereafter, the overall hysterectomy rate declined and phased out around 210/100,000 person-years in 2003, a decrease of 11%. Comprising only 4% of hysterectomies performed in 1987, vaginal hysterectomy increased to 31% in 2003. Rates of vaginal hysterectomy by prolapse indication increased by a five-fold, whereas rates of vaginal hysterectomy by other benign indications increased by a near 20-fold. Total and subtotal abdominal hysterectomy decreased from 63% and 32%, respectively, in 1987, to 48% and 18% in 2003.
Conclusion:
The overall rate of hysterectomy on benign indications has remained reasonably stable in Sweden over the last decade. Major trends involved a considerable decrease in rates of abdominal hysterectomy, increased use of vaginal hysterectomy and increased number of hysterectomies performed for pelvic organ prolapse.
