Technicity in Canada: A Nationwide Whole-Population Analysis of Temporal Trends and Variation in Minimally Invasive Hysterectomies

Abstract

Measurements and Main Results: A total of 369 520 hysterectomies were performed in Canada during the 10-year period, during which the hysterectomy rate decreased from 313 to 243 per 100 000 women. The proportion of abdominal hysterectomies decreased (59.5% to 36.9%), laparoscopic hysterectomies increased (10.8% to 38.6%), and vaginal hysterectomies decreased (29.7% to 24.5%), whereas the national technicity index increased from 40.5% to 63.1% (p <.001, all trends). The median length of stay decreased from 3 (interquartile range 2−4) days to 2 (interquartile range 1−3), and the proportion of patients discharged within 24 hours increased from 2.1% to 7.2%. In year 2016-17, women aged 40 to 49 years had significantly increased risk of abdominal hysterectomy compared with women undergoing hysterectomy in other age categories (p <.001). Comparing women with menstrual bleeding disorders, women undergoing hysterectomy for endometriosis (adjusted relative risk [aRR] 1.36; 95% confidence interval [CI], 1.28−1.44) and myomas (aRR 2.01; 95% CI, 1.94−2.08) were at increased risk of abdominal hysterectomy, whereas women undergoing hysterectomy for pelvic organ prolapse and pelvic pain (aRR 1.47; 95% CI, 1.41−1.53) were at decreased risk.

Day surgery for endometriosis in Canada: A retrospective cohort of trend and regional variation in types of surgeries and their complications

“…[22][23][24] With advances in technology, laparoscopic surgery has become safer and better over the years, 25 and has become one of the most common surgical options in gynaecological surgery. 26,27 Aside from technological improvements, physicians' abilities to perform minimally invasive procedures have improved over time in Canada, 8,28,29 As for regional differences in perioperative complication rates, we found that the provinces with the highest proportion of rural populations experienced the highest complications rates as compared to the province with the lowest proportion of rural populations. However, the underlying reasons for these disparities are not entirely obvious, and there is a paucity of literature on this issue.…”

“…An explanation for the increase in laparoscopic hysterectomy may be related to an increase of the technicity index, an indicator of the proportion of hysterectomies that are done through minimally invasive surgery, over these years in Canada. 8 In addition, the observed decline in the rate of minor conservative surgeries during the study period might be due to a change toward non-invasive methods of diagnosing endometriosis in Canada in recent years. 4 The regional variation of day surgeries might relate to differences in population characteristics as well as regional variations in healthcare access, environmental exposures, practice variations and preferences of populations.…”

“…An explanation for the increase in laparoscopic hysterectomy may be related to an increase of the technicity index, an indicator of the proportion of hysterectomies that are done through minimally invasive surgery, over these years in Canada 8 . It indicates a decrease in abdominal hysterectomies and/or an increase in laparoscopic hysterectomies over time.…”

“…The proportion of surgeries on the same day of hospitalisation has increased in Canada due to the improvement in minimally invasive techniques in the last decade. 8 However, data on the frequency of day surgeries for endometriosis and the risk of complications are scarce. Moreover, no surveillance has been reported on the risk of complications through the years and regional variations in Canada.…”

Predicting major complications in patients undergoing laparoscopic and open hysterectomy for benign indications

“…1 Minimal access approaches are favoured by both clinicians and patients, 2 and the proportion of hysterectomies being undertaken by a laparoscopic approach has increased substantially in many countries over the last 10 years. [3][4][5][6][7] The evidence-based medicine paradigm for surgical approaches to hysterectomy for benign disease advocates that the chosen surgical approach should be discussed with the patient by their surgeon and decided in light of the relative benefits and risks. 2 This advice is echoed by national guidelines.…”