title: Surgery for menorrhagia within English regions: variation in rates of endometrial ablation and hysterectomy.
abstract: OBJECTIVE
  To examine variation between English regions in the use of surgery (endometrial ablation or hysterectomy) for the treatment of menorrhagia.
  
  
  METHODS
  Analysis of Hospital Episodes Statistics (HES) data to produce rates of surgery for English Strategic Health Authorities (SHAs) and Primary Care Trusts (PCTs).
  
  
  METHODS
  Women aged between 25 and 59 years who had endometrial ablation or hysterectomy for menorrhagia between April 2003 and March 2006 in English NHS hospitals.
  
  
  METHODS
  Multilevel Poisson regression was used to determine the level of systematic variation in the regional rates of surgery and their association with regional characteristics (deprivation, service provision and mix of surgical procedures).
  
  
  METHODS
  Age-standardised annual rates of surgery.
  
  
  RESULTS
  The English rate of surgery for menorrhagia was 143 procedures per 100 000 women. Surgical rates within SHAs ranged from 52 to 230 procedures per 100 000 women, while rates within PCTs ranged from 20 to 420 procedures per 100 000 women. While, 60% of all procedures were endometrial ablations, the proportion across SHAs varied, ranging from 46% to 75%. Surgery rates were associated with the regional characteristics, but only weakly, and risk adjustment reduced the amount of unexplained variation by <15% at both SHA and PCT levels.
  
  
  CONCLUSIONS
  Regional differences in surgical rates for menorrhagia have persisted despite changes in practice and improved evidence, suggesting there is scope for improving the management of menorrhagia within England.
authors: Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, UK. david.cromwell@lshtm.ac.uk
authors: D A
authors: DA
authors: Cromwell
authors: T A
authors: TA
authors: Mahmood
authors: A
authors: A
authors: Templeton
authors: J H
authors: JH
authors: van der Meulen
mesh_terms: D000328:Adult; D055356:Endometrial Ablation Techniques / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data*; D008595:Menorrhagia / Q000601:surgery*; D008875:Middle Aged; D012044:Regression Analysis; D012111:Residence Characteristics