Hysterectomy in Denmark 1977–2011: changes in rate, indications, and hospitalization

Abstract

Objective

To describe conditions regarding hysterectomy for benign indications during the past 35 years in Denmark.

Study design

Population-based register study of 167,802 women who underwent hysterectomy for benign conditions in the period 1977–2011. Patient data regarding operative techniques, hospitalization, indications, patient age, and geography were extracted from the Danish National Patient Register.

Results

The overall rate of hysterectomy was around 180/100,000 woman years during the period. A rise in laparoscopic and vaginal hysterectomy was seen at the expense of abdominal hysterectomy. The indication of pelvic organ prolapse and abnormal uterine bleeding increased while the indication of fibroids decreased. The average age of women at time of hysterectomy increased from 46 years in 1977–1981 to 50 years in 2006–2011. The mean number of hospitalization days was reduced by 75%. Regional differences were detected regarding route of hysterectomy and hospitalization.

Conclusions

This study demonstrates a change in the pattern of indications for hysterectomy, increased age of the affected women, reduced length of stay in the hospital, and a rise in the percentage of minimal invasive surgical procedures.

Introduction

Hysterectomy is the most common major gynecological procedure with approximately 4500 operations per year in Denmark [1], [2]. Hysterectomy is the ultimate treatment for conditions such as abnormal uterine bleeding (AUB), fibroids and uterine prolapse. Several alternatives to hysterectomy have emerged, such as the levonorgestrel-releasing intrauterine device, endometrial ablation for abnormal uterine bleeding [3], and embolization and radiofrequency ablation of uterine fibroids [4]. Nevertheless the hysterectomy rate for benign indications has previously been described as stable through many decades in Denmark with yearly rates around 200/100,000 women [1], [2]. This is comparable to other Scandinavian countries [5], [6] but much lower than rates reported from Germany [7] and North America [8], [9].

In Denmark, the proportions of the different benign indications for hysterectomy have previously been described as unchanged over a 10-year period, with fibroids and AUB accounting for 55% of all hysterectomies and accounting for 42% and 25% respectively of benign indications [2]. The same trend is described in the USA [9] and Sweden [5] although the proportion of fibroids of 51% is larger than in Denmark.

For some years the trend in hysterectomy has been toward the use of more minimally invasive techniques [1], [10]. This change has been supported by shorter recovery time, fewer infections, and fewer days of hospitalization [11]. In 1977 hysterectomy was a major operation requiring long hospitalization: for example a study from 1977 described how hospitalization following vaginal hysterectomy was reduced from 12.7 to 7.2 days [12]. Later fast track programs have decreased hospitalization days [13] and now laparoscopic [14] and vaginal hysterectomy [15] can be organized as outpatient procedures.

The aim of this study was to describe surgical techniques, indications, patient age, hospitalization, and regional differences during the past 35 years regarding hysterectomy on benign indication in Denmark.