Hysterectomy in Germany
Hysterectomy elevates the risk of stroke and coronary heart disease in young women when combined with the removal of both ovaries in the same operation. This fact provides the background for the epidemiological report by Andreas Stang and colleagues on hysterectomy rates in Germany, which appears in the current issue of Deutsches Ärzteblatt International (Dtsch Arztebl Int 2011; 108: 508-14).
Removal of the uterus (hysterectomy) is among the commonest procedures in surgical gynecology. Stang et al. based their report on nationwide statistics relating to diagnosis-related groups (DRGs) in Germany for the years 2005 and 2006. They found that 4% of women under 50 who underwent hysterectomy for an indication other than cancer had a bilateral oophorectomy in the same operation, even though recent studies have shown that this is associated with an elevated risk of stroke and coronary heart disease.
The epidemiologists’ assessment also revealed marked regional variation in hysterectomy rates across Germany.
Fewer women underwent hysterectomy for benign indications in Hamburg, for example, than in Mecklenburg–West Pomerania over the same interval. Factors influencing the hysterectomy rate included not just the patient’s concomitant illnesses, but also her social status and health insurance class and the sex of the gynecologist.
Contact: Dr. Andreas Stang
Deutsches Aerzteblatt International
Background: Hysterectomy is among the more common
surgical procedures in gynecology. The aim of this study
was to calculate population-wide rates of hysterectomy
across Germany and to obtain information on the different
modalities of hysterectomy currently performed in German
hospitals. This was done on the basis of nationwide DRG
statistics (DRG = diagnosis-related groups) covering the
Methods: We analyzed the nationwide DRG statistics for
2005 and 2006, in which we found 305 015 hysterec-
tomies. Based on these data we calculated hysterectomy
rates for the female population. We determined the indi-
cations for each hysterectomy with an algorithm based on
the ICD-10 codes, and we categorized the operations on
the basis of their OPS codes (OPS = Operationen- und
Prozedurenschlüssel [Classification of Operations and
Results: The overall rate of hysterectomy in Germany was
362 per 100 000 person-years. 55% of hysterectomies for
benign diseases of the female genital tract were per -
formed transvaginally. Bilateral ovariectomy was per -
formed concomitantly in 23% of all hysterectomies, while
4% of all hysterectomies were subtotal. Hysterectomy
rates varied considerably across federal states: the rate
for benign disease was lowest in Hamburg (213.8 per
100 000 women per year) and highest in Mecklen-
burg–West Pomerania (361.9 per 100 000 women per
Conclusion: Hysterectomy rates vary markedly from one
region to an other. Moreover, even though recent studies
have shown that bilat eral ovariectomy is harmful to
women under 50 who undergo hysterectomy for benign
disease, it is still performed in 4% of all hysterectomies for
benign indications in Germany.