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Technicity in Canada: A nationwide whole population analysis of temporal trends and variation in minimally invasive hysterectomies.

Abstract：

STUDY OBJECTIVE:The objective of our study is to provide a contemporary description of hysterectomy practice and temporal trends in Canada. DESIGN:A national whole population retrospective analysis of data from the Canadian Institute for Health Information SETTING: Canada PATIENTS: All women who underwent hysterectomy for benign indication from 01/04/2007 to 31/03/2017 in Canada. INTERVENTIONS:Hysterectomy MEASUREMENTS AND MAIN RESULTS: A total of 369,520 hysterectomies were performed in Canada during the ten-year period, during which hysterectomy rate decreased from 313 to 243/100,000 women. The proportion of abdominal hysterectomies decreased (59.5% to 36.9%); laparoscopic hysterectomies increased (10.8% to 38.6%); vaginal hysterectomies decreased (29.7% to 24.5%); while the national technicity index increased from 40.5% to 63.1% (p<0.001, all trends). Median length of stay decreased from 3 (interquartile range 2, 4) days to 2 (IQR 1, 3), and proportion of patients discharged within 24 hours increased from 2.1% to 7.2%. In year 2016/17, women age 40-49 years had significantly increased risk of abdominal hysterectomy compared with women undergoing hysterectomy in other age categories (p<0.001). Comparing women with menstrual bleeding disorders, women undergoing hysterectomy for endometriosis (adjusted relative risk 1.36, 95% confidence interval [1.28-1.44]), fibroids (aRR2.01, 95%CI[1.94-2.08]) were at increased risk of abdominal hysterectomy, while women undergoing hysterectomy for pelvic organ prolapse and pelvic pain (aRR1.47, 95%CI[1.41-1.53]) were at decreased risk. Using Ontario as the comparator, Nova Scotia (aRR 1.35, 95%CI[1.27-1.43]), New Brunswick (aRR1.25, 95%CI[1.18-1.32]), Manitoba (aRR1.35, 95%CI[1.28-1.43]) and Newfoundland (aRR1.18, 95%CI[1.10-1.27]), had significantly higher risks of abdominal hysterectomy; whereas Saskatchewan (aRR0.75, 95%CI[0.74-0.77]) and British Columbia (aRR0.86, 95%CI[0.85-0.88]) had significantly lower risks; while Prince Edward Island and Quebec and Alberta were not significantly different. CONCLUSION:Minimally invasive hysterectomy for benign indication has increased significantly in Canada. The declining use of vaginal approaches and the variation between provinces are of concern and necessitate further study.

journal_name

J Minim Invasive Gynecol

journal_title

Journal of minimally invasive gynecology

authors

Chen I,Mallick R,Allaire C,Bajzak KI,Belland LM,Bougie O,Cassell KA,Choudhry AJ,Cundiff GW,Kroft J,Leyland NA,Maheux-Lacroix S,Rajakumar C,Randle E,Robertson D,Thiel JA,Tulandi T,Yong PJ,Laberge PY

doi

10.1016/j.jmig.2021.01.010

subject

Has Abstract

pub_date

2021-01-18 00:00:00

eissn

1553-4650

issn

1553-4669

pii

S1553-4650(21)00038-8

pub_type

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Technicity in Canada: A nationwide whole population analysis of temporal trends and variation in minimally invasive hysterectomies.