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.