National Technicity on the Rise: Ten Year Minimally Invasive Hysterectomy Trends for Women with Benign Uterine Disease in Canada

Abstract

Study Objective Hysterectomies are the most commonly performed gynecologic procedure and are associated with faster recovery and decreased complications when performed minimally invasively compared with abdominally. The objectives were to measure temporal trends in minimally invasive hysterectomy for Canada and each province/territory and to determine whether provincial/territorial differences exist. Design National population-based retrospective study using federal administrative data from the Canadian Institute for Health Information. Technicity index (proportion of vaginal and laparoscopic hysterectomies) was calculated. Cochrane-Armitage test was applied for temporal trends and 2-sided p-values Setting Canada Patients or Participants All patients undergoing hysterectomy for benign indications in Canada from FY2006/7 to FY2016/17 Interventions Hysterectomy Measurements and Main Results 369,740 hysterectomies were included (48.4% abdominal; 28.3% laparoscopic; 23.3% vaginal). Mean age was 48.5 years (SD 11.2 years), and indications for surgery were menstrual bleeding disorders (29.7%), fibroids (23.7%), pelvic organ prolapse(19.8%), other(17.4%), endometriosis(5.8%) and pelvic pain(3.6%). National technicity index (proportion of vaginal and laparoscopic hysterectomies) increased (40.5%⟶63.2%). Abdominal hysterectomy decreased (59.5%⟶36.8%); laparoscopic increased (10.8%⟶38.6%); while, vaginal decreased (29.7%⟶24.5%). (p Increasing technicity index was observed in all provinces, though with variable increase over time. (p Manitoba(36.9%⟶44.4%; RR1.50,95%CI[1.43-1.58]*), Nova Scotia(46.4%⟶48.5%; RR1.39[1.31-1.48]*), New Brunswick(43.7%⟶50.3%; RR1.34[1.26-1.44]*), Newfoundland(35.3%⟶55.2%; RR1.21[1.10-1.33]*), Ontario (39.4%⟶63.0%, RR1.00[reference])Quebec(42.0%⟶61.8%; RR1.03[0.99-1.07]), Prince Edward Island(54.9%⟶64.3%; RR0.96[0.81-1.15]), Alberta(34.0%⟶64.3%; RR0.96[0.92-1.01]), British Columbia(43.4%⟶72.1%; RR 0.75[0.71-0.79]*), Saskatchewan(47.7%⟶83.9%; RR0.44[0.39-0.49]*). Conclusion Minimally invasive hysterectomy for benign indication has increased significantly in Canada over the past decade. However, the increase reflects increasing use of laparoscopic hysterectomy with a declining use of vaginal hysterectomy. The variation between provinces represents a technicity gap that warrants further study and intervention.