caa a22 4500 397577141 CHVBK 20180308164859.0 cr unu---uuuuu 161202e199612 xx s 000 0 eng 10.1093/oxfordjournals.pubmed.a024537 doi (NATIONALLICENCE)oxford-10.1093/oxfordjournals.pubmed.a024537 Regional variations in the utilization rate of vaginal and abdominal hysterectomies in the United Kingdom [Elektronische Daten] [Clive Mulholland, Nancy Harding, Suzanne Bradley, Mike Stevenson] Background Large geographic variations in hysterectomy rates are well known; however, very little is known about geographic variations in the route of the procedure, i.e.whether it is performed abdominally or vaginally. We compared utilization rates for abdominal and vaginal hysterectomies for the 14 Regional Health Authorities of England, and Northern Ireland over a three-year period. Methods Data were collected in the form of hospital episode statistics and small area analysis techniques were used to document regional variations. Results Large regional differences in the utilization of vaginal hysterectomies were recorded. Three areas in particular (Northern Ireland, Yorkshire and NW Thames)displayed high vaginal to abdominal ratios. Northern Ireland recorded the highest ratio (0⋅366), Mersey Regional Health Authority the lowest (0⋅139). The use of the vaginal route was found to increase with age, and was the most common route for the >65 years age group. Conclusion Despite an increasing volume of evidence advocating the use of the vaginal route, there appears to be a resistance to its use, except in older women. The role of physician practice style, and in particular group clinical judgement, is highlighted as being significantly involved in explaining the observed geographic variations. © Oxford University Press Articles nationallicence hysterectomy nationallicence abdominal nationallicence vaginal nationallicence utilization nationallicence Mulholland Clive Health and Health Care Research Unit, The Queens University of Belfast, Mulhouse Building, Institute of Clinical Science Grosvenor Road, Belfast BT12 6BJ aut Harding Nancy Institute of Health Care Studies, University of Wales Singleton Park, Swansea SA2 8PP aut Bradley Suzanne Health and Health Care Research Unit, The Queens University of Belfast aut Stevenson Mike Health and Health Care Research Unit, The Queens University of Belfast aut Journal of Public Health Oxford University Press 18/4(1996-12), 400-405 1741-3842 18:4<400 1996 18 pubmed https://doi.org/10.1093/oxfordjournals.pubmed.a024537 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1093/oxfordjournals.pubmed.a024537 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Mulholland Clive Health and Health Care Research Unit, The Queens University of Belfast, Mulhouse Building, Institute of Clinical Science Grosvenor Road, Belfast BT12 6BJ aut NATIONALLICENCE 700 1- Harding Nancy Institute of Health Care Studies, University of Wales Singleton Park, Swansea SA2 8PP aut NATIONALLICENCE 700 1- Bradley Suzanne Health and Health Care Research Unit, The Queens University of Belfast aut NATIONALLICENCE 700 1- Stevenson Mike Health and Health Care Research Unit, The Queens University of Belfast aut NATIONALLICENCE 773 0- Journal of Public Health Oxford University Press 18/4(1996-12), 400-405 1741-3842 18:4<400 1996 18 pubmed Metadata rights reserved CC BY-NC-4.0 http://creativecommons.org/licenses/by-nc/4.0 nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-oxford