title: Hysterectomy rates for benign indications.
abstract: OBJECTIVE
  To investigate the annual rates, types, and indications for hysterectomies performed for benign disease in Kaiser Permanente Northern California from 1994 to 2003.
  
  
  METHODS
  All women, 20 years or age or older, who were undergoing hysterectomy for benign indications in Kaiser Permanente Northern California from 1994 to 2003 were identified. We analyzed hysterectomy rates by type, indication, and age group. Changes over time were analyzed with the Cochran-Armitage test for linear trend.
  
  
  RESULTS
  From 1994 to 2003, there were 32,321 hysterectomies performed for benign indications. Hysterectomy rates showed a significant decline, from 4.01 per 1,000 women in 1994 to 3.41 per 1,000 women in 2003 (P for trend < .001). The relative proportions of all hysterectomies performed as laparoscopically assisted vaginal hysterectomy (LAVH) peaked at 13.0% in 1995 and then steadily declined to 3.9% in 2003 (P for trend < .001), whereas the relative proportion of subtotal abdominal hysterectomy increased from 6.9% in 1994 to 20.8% in 2003 (P for trend < .001). Hysterectomy rates declined 11.2% for uterine leiomyoma (relative risk [RR] 0.89, 95% confidence interval [CI] 0.83-0.95), 33.1% for endometriosis (RR 0.67, 95% CI 0.59-0.76), and 18.6% for uterine prolapse (RR 0.81, 95% CI 0.72-0.92). The relative proportion performed for uterine leiomyoma was consistently greater than for all other indications combined.
  
  
  CONCLUSIONS
  The rates of hysterectomy for benign indications are decreasing. The type of hysterectomy changed significantly, with LAVH performed less frequently and subtotal abdominal hysterectomy increasing in popularity. Uterine leiomyoma remains the most common indication for benign hysterectomy.
  
  
  METHODS
  II-2.
authors.affiliation: Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, USA. gavin.Jacobson@kp.org
authors.forename: Gavin F
authors.initials: GF
authors.lastname: Jacobson
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Shaber
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Armstrong
authors.forename: Yun-Yi
authors.initials: YY
authors.lastname: Hung
mesh_terms: D002140:California / Q000453:epidemiology; D004715:Endometriosis / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data* / Q000639:trends; D007045:Hysterectomy, Vaginal / Q000706:statistics & numerical data / Q000639:trends; D007889:Leiomyoma / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D014594:Uterine Neoplasms / Q000601:surgery