Changes in Hysterectomy Route and Adnexal Removal for Benign Disease in Australia 2001-2015: A National Population-Based Study.

Stephen J. Robson,Natalie De Cure

doi:10.1155/2018/5828071

Stephen J. Robson, Natalie De Cure

Open Access

https://doi.org/10.1155/2018/5828071

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Abstract

Objective Hysterectomy rates have fallen over recent years and there remains debate whether salpingectomy should be performed to reduce the lifetime risk of ovarian cancer. We examined trends in adnexal removal and route of hysterectomy in Australia between 2001 and 2015. Methods Data were obtained from the national procedural dataset for hysterectomy approach (vaginal, VH; abdominal, AH; and, laparoscopic, LH) and rates of adnexal removal, as well as endometrial ablation. The total female population in two age groups (“younger age group,” 35 to 54 years, and “older age group,” 55 to 74 years) was obtained from the Australian Bureau of Statistics. Results The rate of hysterectomy fell in both younger (61.7 versus 45.2/10000/year, p < 0.005) and older (38.8 versus 33.2/10000/year, p < 0.005) age groups. In both age groups there were significant decreases in the incidence rates for VH (by 53% in the younger age group and 29% in the older age group) and AH (by 53% and 55%, respectively). The rates of LH increased by 153% in the younger age group and 307% in the older age group. Overall, the proportion of hysterectomies involving adnexal removal increased (31% versus 65% in the younger age group, p < 0.005; 44% versus 58% in the older age group, p < 0.005). The increase occurred almost entirely after 2011. Conclusion Hysterectomy is becoming less common, and both vaginal and abdominal hysterectomy are being replaced by laparoscopic hysterectomy. Removal of the adnexae is now more common in younger women.

Highlights

Hysterectomy for benign conditions remains a common procedure in Australia and internationally
Updating previous evidence [9, 10] a recent systematic review comparing total laparoscopic hysterectomy (TLH) with vaginal hysterectomy (VH) included 24 studies published to February 2016 and reported no difference between the two techniques in the rate of major or minor complications, risk of ureter and bladder injuries, intraoperative blood loss, and length of hospital stay [11]
The total number of hysterectomies performed in Australia by each route is presented in Figure 2 and Figure 3

Summary

Introduction

Hysterectomy for benign conditions remains a common procedure in Australia and internationally. Prior to 2000, the lifetime risk of hysterectomy in Australian women was estimated to be approximately 35% [1], similar to the rate in other developed countries [2, 3]. Since 2000—associated with the introduction of treatments such as the levonorgestrel-releasing intrauterine system (Mirena6) and second-generation endometrial ablation techniques—the rate of hysterectomy has fallen [4]. Over the same period nonsurgical treatments for fibroids such as uterine artery embolization and focussed ultrasound might be expected to reduce further the rate of hysterectomy [5, 6]. Vaginal access and uterine size impose limitations on uptake of vaginal hysterectomy and there is a body of evidence supporting a laparoscopic

Methods

Results

Conclusion