Regional variation of hysterectomy for benign uterine diseases in Switzerland

Abstract

Background Hysterectomy is the last treatment option for benign uterine diseases, and vaginal hysterectomy is preferred over more invasive techniques. We assessed the regional variation in hysterectomy rates for benign uterine diseases across Switzerland and explored potential determinants of variation. Methods We conducted a population-based analysis using patient discharge data from all Swiss hospitals between 2013 and 2016. Hospital service areas (HSAs) for hysterectomies were derived by analyzing patient flows. We calculated age-standardized mean procedure rates and measures of regional variation (extremal quotient [EQ], highest divided by lowest rate) and systematic component of variation [SCV]). We estimated the reduction in the variance of crude hysterectomy rates across HSAs in multilevel regression models, with incremental adjustment for procedure year, age, cultural/socioeconomic factors, burden of disease, and density of gynecologists. Results Overall, 40,211 hysterectomies from 54 HSAs were analyzed. The mean age-standardized hysterectomy rate was 298/100,000 women (range 186-456). While the variation in overall procedure rate was moderate (EQ 2.5, SCV 3.7), we found a very high procedure-specific variation (EQ vaginal 5.0, laparoscopic 6.3, abdominal 8.0; SCV vaginal 17.5, laparoscopic 11.2, abdominal 16.9). Adjusted for procedure year, demographic, cultural, and sociodemographic factors, a large share (64%) of the variance remained unexplained (vaginal 63%, laparoscopic 85%, abdominal 70%). The main determinants of variation were socioeconomic/cultural factors. Burden of disease and the density of gynecologists was not associated with procedure rates.

High regional variation in prostate surgery for benign prostatic hyperplasia in Switzerland

“…French/Italian speaking areas had a 21% lower prostate surgery rate than Swiss German language regions, possibly due to more conservative physician practice styles or patient preferences for less invasive treatments. We previously have observed lower rates of other preference-sensitive surgical interventions in the French/Italian speaking parts of Switzerland, including vertebroplasty, hysterectomy and joint replacement [19,55,56]. We found no association between semi-/private insurance and prostatectomy rates, arguing against the suspicion that a semi-/private insurance (which results in higher physician fees) may fuel overtreatment in Switzerland.…”

“…We conducted a population-based, small area variation analysis using routinely collected patient discharge data from all Swiss public and private acute care hospitals and census data for calendar years 2013-2018. The method has been described previously [18,19]. Swiss hospitals are legally obligated to provide the Swiss Federal Statistical Office (SFSO) with an anonymized, standardized data set for each hospital discharge, which includes demographic information, procedure codes based on the Swiss Classification of Operations (CHOP; an adaptation of the U.S. ICD-9-CM volume 3 procedure classification), and diagnostic codes based on the International Classification of Diseases, 10 th revision, German Modification (ICD-10-GM) [20].…”

Trends and regional variation in vertebroplasty and kyphoplasty in Switzerland: a population-based small area analysis

“…A large metaanalysis eventually showed no clinically relevant benefits of VP in 2018 [18] and, in early 2019, the American Society for Bone and Mineral Research (ASBMR) recommended against routine use of vertebral augmentation for osteoporotic vertebral fractures [65]. Large amounts of variation in procedure rates across Switzerland is not an isolated phenomenon for VP/BKP and has also been reported for other orthopedic interventions (e.g., SCV >33 for shoulder arthroscopy [66]) or hysterectomy (e.g., SCV >16 for abdominal hysterectomy [37]). The similar levels of regional variation may signal unequal access to surgery and widely differing physician's opinions regarding surgical interventions across the country.…”

The Epidemiology Profile of Hysterectomy in Northern Zimbabwean Women

“…However, a study on the regional variation of hysterectomy for benign uterine diseases in Switzerland assesses the relationship between hysterectomy and regional variation and further explores potential determinants of the variation. (Nina Stoller, 2020). Switzerland did this by conducting a retrospective health surveillance on hysterectomy.…”