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European Journal of Epidemiology

, Volume 26, Issue 2, pp 125–133 | Cite as

Nationwide rates of conversion from laparoscopic or vaginal hysterectomy to open abdominal hysterectomy in Germany

  • Andreas StangEmail author
  • Ray M. Merrill
  • Oliver Kuss
Clinical Epidemiology

Abstract

The aim of this study was to provide population-based German-wide hysterectomy rates based on the national hospitalization file and to estimate the rate of conversion from laparoscopical or vaginal hysterectomy to open abdominal hysterectomy. Nationwide population-based DRG (diagnosis related groups) data of the years 2005 and 2006 were used to calculate hysterectomy rates by indication group and type of surgical approach. Overall 305,015 hysterectomies were performed during the study period (4.5 out of 1,000 women aged 20 years or more). The hysterectomy rate for benign diseases of the genital tract among women aged 20 years or more (3.6 out of 1,000 women) is higher than in Sweden but lower than in the US or Australia. Only 6 and 5% of all hysterectomies were performed by laparoscopically assisted vaginal hysterectomy and laparoscopic hysterectomy, respectively. Twenty-six percent of hysterectomies for benign diseases among women aged 50 years or more included bilateral oophorectomy. 10% of laparoscopical hysterectomies and 1% of vaginal hysterectomies necessitated a conversion to an abdominal hysterectomy. For both types of hysterectomies, the conversion rates were highest for primary malignant genital tract cancer and other cancers compared to the other indication groups. Whereas the conversion rate for laparoscopical hysterectomies increased by age, this rate did not change by age for vaginal hysterectomies. Conversion from laparoscopically or vaginal hysterectomy to open abdominal hysterectomy is associated with the indication and type of hysterectomy started with and is considerably higher for laparoscopic than vaginal hysterectomies.

Keywords

Epidemiology Germany Hospital data Hysterectomy Incidence Population-based 

Notes

Acknowledgments

We are very grateful for the many helpful comments by Katrina Spilsbury, CHIRI, Centre for Population Health Research, Curtin University of Technology, Perth, Western Australia, on an earlier draft of this manuscript. We thank Mareike Kunze, Institut für Medizinische Epidemiologie, Biometrie und Informatik, Universitätsklinikum Halle und Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale) University of Halle, for the preparation of the figures.

Conflict of interest

None to declare.

Supplementary material

10654_2010_9543_MOESM1_ESM.doc (52 kb)
Supplementary material 1 (DOC 53 kb)

References

  1. 1.
    Lefebvre G, Allaire C, Jeffrey J, Vilos G, Arneja J, Birch C, et al. SOGC clinical guidelines. Hysterectomy. J Obstet Gynaecol Can. 2002;24(1):37–61.PubMedGoogle Scholar
  2. 2.
    Whiteman MK, Hillis SD, Jamieson DJ, Morrow B, Podgornik MN, Brett KM, et al. Inpatient hysterectomy surveillance in the United States, 2000–2004. Am J Obstet Gynecol. 2008;198(1):34–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Merrill RM. Hysterectomy surveillance in the United States, 1997 through. Med Sci Monit. 2008;4(1):CR24–31.Google Scholar
  4. 4.
    Roos NP. Hysterectomy: variations in rates across small areas and across physicians’ practices. Am J Public Health. 1984;74(4):327–35.CrossRefPubMedGoogle Scholar
  5. 5.
    McPherson K, Wennberg JE, Hovind OB, Clifford P. Small-area variations in the use of common surgical procedures: an international comparison of New England, England, and Norway. N Engl J Med. 1982;307(21):1310–4.CrossRefPubMedGoogle Scholar
  6. 6.
    Keskimaki I, Aro S, Teperi J. Regional variation in surgical procedure rates in Finland. Scand J Soc Med. 1994;22(2):132–8.PubMedGoogle Scholar
  7. 7.
    Spilsbury K, Semmens JB, Hammond I, Bolck A. Persistent high rates of hysterectomy in Western Australia: a population-based study of 83,000 procedures over 23 years. BJOG. 2006;113(7):804–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Vuorma S, Teperi J, Hurskainen R, Keskimaki I, Kujansuu E. Hysterectomy trends in Finland in 1987–1995—a register based analysis. Acta Obstet Gynecol Scand. 1998;77(7):770–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Lundholm C, Forsgren C, Johansson AL, Cnattingius S, Altman D. Hysterectomy on benign indications in Sweden 1987–2003: a nationwide trend analysis. Acta Obstet Gynecol Scand. 2009;88(1):52–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Domenighetti G, Luraschi P, Marazzi A. Hysterectomy and sex of the gynecologist. N Engl J Med. 1985;313(23):1482.PubMedGoogle Scholar
  11. 11.
    Domenighetti G, Casabianca A. Rate of hysterectomy is lower among female doctors and lawyers’ wives. BMJ. 1997;314(7091):1417.PubMedGoogle Scholar
  12. 12.
    Domenighetti G, Luraschi P, Casabianca A, Gutzwiller F, Spinelli A, Pedrinis E, et al. Effect of information campaign by the mass media on hysterectomy rates. Lancet. 1988;2(8626–8627):1470–3.CrossRefPubMedGoogle Scholar
  13. 13.
    Gimbel H, Settnes A, Tabor A. Hysterectomy on benign indication in Denmark 1988–1998. A register based trend analysis. Acta Obstet Gynecol Scand. 2001;80(3):267–72.PubMedGoogle Scholar
  14. 14.
    Settnes A, Jorgensen T, Lange AP. Hysterectomy in Danish women: weight-related factors, psychologic factors, and life-style variables. Obstet Gynecol. 1996;88(1):99–105.CrossRefPubMedGoogle Scholar
  15. 15.
    Stang A, Stausberg J. Inpatient management of patients with skin cancer in Germany: an analysis of the nationwide DRG-statistic 2005–2006. Br J Dermatol. 2009;161(Suppl 3):99–106.CrossRefPubMedGoogle Scholar
  16. 16.
    Stang A, Katalinic A, Dieckmann KP, Pritzkuleit R, Stabenow R. A novel approach to estimate the German-wide incidence of testicular cancer. Cancer Epidemiol. 2010;34:13–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Stang A, Weichenthal M. Micrographic surgery of skin cancer in German hospitals 2005–2006. J Eur Acad Dermatol Venereol. 2010.Google Scholar
  18. 18.
    ICD-10-GM 2005 Systematisches Verzeichnis: Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme, 10. Revision—German Modification. Köln: Deutscher Ärzteverlag; 2004.Google Scholar
  19. 19.
    ICD-10-GM 2006 Systematisches Verzeichnis: Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme. Köln: Deutscher Ärzteverlag; 2006.Google Scholar
  20. 20.
    OPS 2005 Systematisches Verzeichnis. Köln: Deutscher Ärzteverlag; 2005.Google Scholar
  21. 21.
    OPS 2006 Systematisches Verzeichnis. Köln: Deutscher Ärzteverlag; 2006.Google Scholar
  22. 22.
    Keshavarz H, Hillis SD, Kieke BA. Hysterectomy surveillance—United States, 1994–1999. MMWR. 2002;51(SS05):1–8.Google Scholar
  23. 23.
    Senator für Arbeit FGJuS. Frauengesundheitsbericht Bremen 2001. Bremen: Media Meter; 2001.Google Scholar
  24. 24.
    Merrill RM, Lyon JL, Wiggins C. Comparison of two methods based on cross-sectional data for correcting corpus uterine cancer incidence and probabilities. BMC Cancer. 2001;1:13.CrossRefPubMedGoogle Scholar
  25. 25.
    Greenland S. Introduction to regression models. In: Rothman KJ, Greenland S, Lash TL, editors. Modern epidemiology. 3rd ed. Philadelphia: Wolters Kluwer, Lippincott Williams & Wilkins; 2008. p. 381–417.Google Scholar
  26. 26.
    Elandt-Johnson RC. Definition of rates: some remarks on their use and misuse. Am J Epidemiol. 1975;102(4):267–71.PubMedGoogle Scholar
  27. 27.
    SAS for windows [computer program]. Cary, NC: SAS Institute; 2002.Google Scholar
  28. 28.
    Jacobson GF, Shaber RE, Armstrong MA, Hung YY. Hysterectomy rates for benign indications. Obstet Gynecol. 2006;107(6):1278–83.CrossRefPubMedGoogle Scholar
  29. 29.
    Julian TM. Vaginal hysterectomy: an apparent exception to evidence-based decision making. Obstet Gynecol. 2008;111(4):812–3.CrossRefPubMedGoogle Scholar
  30. 30.
    Leonard F, Chopin N, Borghese B, Fotso A, Foulot H, Coste J, et al. Total laparoscopic hysterectomy: preoperative risk factors for conversion to laparotomy. J Minim Invasive Gynecol. 2005;12(4):312–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Ng CC, Chern BS, Siow AY. Retrospective study of the success rates and complications associated with total laparoscopic hysterectomy. J Obstet Gynaecol Res. 2007;33(4):512–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Tohic AL, Dhainaut C, Yazbeck C, Hallais C, Levin I, Madelenat P. Hysterectomy for benign uterine pathology among women without previous vaginal delivery. Obstet Gynecol. 2008;111(4):829–37.CrossRefPubMedGoogle Scholar
  33. 33.
    Eisenkop SM. Total laparoscopic hysterectomy with pelvic/aortic lymph node dissection for endometrial cancer—a consecutive series without case selection and comparison to laparotomy. Gynecol Oncol. 2010;117(2):216–23.CrossRefPubMedGoogle Scholar
  34. 34.
    Tunitsky E, Citil A, Ayaz R, Esin S, Knee A, Harmanli O. Does surgical volume influence short-term outcomes of laparoscopic hysterectomy? Am J Obstet Gynecol. 2010;203(1):24–6.CrossRefPubMedGoogle Scholar
  35. 35.
    Camanni M, Mistrangelo E, Febo G, Ferrero B, Deltetto F. Prophylactic bilateral oophorectomy during vaginal hysterectomy for benign pathology. Arch Gynecol Obstet. 2009;280(1):87–90.CrossRefPubMedGoogle Scholar
  36. 36.
    National Center for Health Statistics, Pokras R, Hufnagel V. Hysterectomies in the United States 1965–84. Washington, DC: US Government Printing Office; 1987.Google Scholar
  37. 37.
    Lepine LA, Hillis SD, Marchbanks PA, Koonin LM, Morrow B, Kieke BA, et al. Hysterectomy surveillance—United States. 1980–1993. MMWR. 1997;46(SS-4):1–15.PubMedGoogle Scholar
  38. 38.
    Brett KM, Marsh JV, Madans JH. Epidemiology of hysterectomy in the United States: demographic and reproductive factors in a nationally representative sample. J Womens Health. 1997;6(3):309–16.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  1. 1.Institut für Klinische Epidemiologie, Medizinische FakultätMartin-Luther-Universität Halle-WittenbergHalle (Saale)Germany
  2. 2.Department of Health Science, College of Life SciencesBrigham Young UniversityProvoUSA
  3. 3.Institut für Medizinische Epidemiologie, Biometrie und Informatik, Universitätsklinikum Halle und Medizinische FakultätMartin-Luther-Universität Halle-WittenbergHalle (Saale)Germany

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