Peripartum hysterectomy in Taiwan: Trends, organizational accreditation, and volume effects

To investigate the trend of peripartum hysterectomy as well as the influence of organizational accreditation and volume.

This nationwide population-based retrospective study was conducted by utilizing Taiwan National Health Insurance Research Database. During 2011 to 2021, women aged 18 years or older with delivery hospitalizations were included. Peripartum hysterectomy was identified by current procedure terminology codes from delivery hospitalization or readmission within 42 days postpartum. For trend analysis, Kendall Tau-b correlation was applied. Multivariable logistic regression was used to evaluate the influence of organizational characteristics, including hospital accreditation levels and annual delivery volume, on peripartum hysterectomy.

A total of 1,999,047 delivery hospitalizations were identified during the study period, with 855 surgical procedures of peripartum hysterectomy performed during delivery hospitalization or re-admission within 42 days postpartum. The incidence of peripartum hysterectomy ranged from 3.45 to 5.29 per 10,000 deliveries, yielding an average rate of 4.3 per 10,000 births and revealing a steady trend without significant changes over 11 years. Multivariable regression showed that compared with medical centers, district hospitals or maternity clinics were associated with significantly higher odds of peripartum hysterectomy (OR = 2.751 for district hospital, OR = 3.559 for maternity clinics, all p < 0.0001). Lower delivery volume was associated with increased odds of peripartum hysterectomy in comparison with organizations with high volume (OR = 1.516 for low volume, p = 0.0017; OR = 1.124 for medium volume, p = 0.0318).

The incidence of peripartum hysterectomy in Taiwan remained low and stable over the last decade, with rates comparable to other developed countries. This protective effect was significantly associated with medical centers, regional hospitals, and institutions with higher delivery volume, suggesting that institutional practice and resource availability may play a crucial role in mitigating the risk of peripartum hysterectomy.