REGIONAL VARIATIONS IN THE UTILIZATION RATE OF VAGINAL AND ABDOMINAL HYSTERECTOMIES IN THE UNITED-KINGDOM

Background Large geographic variations in hysterectomy rates are well known; however, very little is known about geographic variations in th e route of the procedure, i.e. whether it is performed abdominally or vaginally. We compared utilization rates for abdominal and vaginal hys terectomies for the 14 Regional Health Authorities of England, and Nor thern ireland over a three-year period. Methods Data were collected in the form of hospital episode statistics and small area analysis techn iques were used to document regional variations. Results Large regiona l differences in the utilization of vaginal hysterectomies were record ed. Three areas in particular (Northern Ireland, Yorkshire and NW Tham es) displayed high vaginal to abdominal ratios. Northern Ireland recor ded the highest ratio (0 . 366), Mersey Regional Health Authority the lowest (0 . 139). The use of the vaginal route was found to increase w ith age, and was the most common route for the > 65 years age group. C onclusion Despite an increasing Volume of evidence advocating the use of the vaginal route, there appears to be a resistance to its use. exc ept in older women. The role of physician practice style, and in parti cular group clinical judgement, is highlighted as being significantly involved in explaining the observed geographic variations.