Objective  To examine variations between regions and hospitals in the proportion of hysterectomies performed abdominally.

Design  Analysis of routine hospital data.

Setting  All National Health Service hospitals in England.

Population  Women aged 18+ hospitalised between April 1998 and March 2001.

Methods  Logistic regression, adjusting for age and diagnosis.

Main outcome measure  Use of the abdominal rather than the vaginal route.

Results  The adjusted proportion of hysterectomies performed abdominally varied from 75–89% between regions, and from 25–99% between hospitals. Diagnosis accounted for nearly a third of the total variation, dwarfing the contributions of age and hospital. About two-thirds of the variation remained unaccounted for.

Conclusion  Despite evidence suggesting that the majority of hysterectomies may be performed vaginally, very few English trust match this.