Hysterectomy on benign indications in Sweden 1987–2003: A nationwide trend analysis

Abstract

To investigate the annual rates, types and indications for hysterectomy on benign indications in Sweden 1987-2003. A nationwide register-based cohort study. The Swedish Inpatient Register. All women hysterectomized for benign disease in Sweden from 1987 through 2003 (n=121,947). Hysterectomy on benign indications calculated as proportions or rates/100,000 person-years. 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. 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.