Trends in Hysterectomy Incidence Rates During 2000–2015 in Denmark: Shifting from Abdominal to Minimally Invasive Surgical Procedures

Abstract

Background Hysterectomy (removal of the uterus) is a common surgical procedure in gynecology. Although minimally invasive surgical procedures have been introduced, hysterectomy is still associated with risk of short- and long-term complications. Given that hysterectomized women are no longer at risk of either hysterectomy or being diagnosed with endometrial or cervical cancer, it is important to describe trends in hysterectomy rates. Objective To describe trends in hysterectomy incidence rates overall and stratified by age, indication, and procedure. Methods Nationwide population-based cohort study using Danish national registries, 2000–2015, was conducted. We calculated the overall hysterectomy-corrected and age-standardized incidence rates of hysterectomy among women ≥20 years old. Incidence rates were stratified by age group, indication, and surgical procedure. We performed trend analyses using Joinpoint regression, thereby estimating the average annual percentage change (AAPC). Results A total of 98,484 women had a hysterectomy during the study period, corresponding to an overall age-standardized, hysterectomy-corrected hysterectomy incidence rate (SIR) of 351.1 per 100,000 person-years (95% CI 348.9;353.3). SIR of hysterectomy declined over time (AAPC −1.4; 95% CI −1.9;-1.0), which was driven by a decline in rates of benign hysterectomy (AAPC −2.1; 95% CI −2.7;-1.6). Irrespective of indication, rates of abdominal hysterectomy declined substantially during the study period and were surpassed by rates of minimally invasive procedures (ie, laparoscopy and robot-assisted laparoscopy) in 2013. Conclusion Hysterectomy-corrected incidence rates of benign hysterectomy declined over time. Irrespective of indication, we observed a shift in surgical procedure over time, from abdominal hysterectomy to minimally invasive surgical procedures.

Malignant Transformation of Postmenopausal Endometriosis: A Systematic Review of the Literature

“…This, in turn, could explain the negative trend over time of previous endometriosis (positive personal history may be missing among asymptomatic women in the absence of a histologic diagnosis) and long-term HRT. Overtreatment could likely have been much more frequent in the past [95,96]. This new analysis suggests that the recurrence of some clinical conditions may be due to a different attitude of gynecologists about the use of major surgery in some pathologies in the past years.…”

“…Interestingly, our correlation analysis showed that these recurrent clinical conditions (history of endometriosis, major surgery, HRT use) decreased significantly over time (especially after 2010). Major surgery in asymptomatic affected women or benign conditions is likely to have decreased over the years based on new and updated recommendations [1,2,95,96]. This, in turn, could explain the negative trend over time of previous endometriosis (positive personal history may be missing among asymptomatic women in the absence of a histologic diagnosis) and long-term HRT.…”

Prevalence of Hysterectomy by Self-Reported Disability Among Canadian Women: Findings from a National Cross-Sectional Survey

“…The foremost limitation of our analysis is the inability to establish temporality of disability preceding hysterectomy and lack of data on hysterectomy timing, indication (which generally vary by age), 44 and concomitant oophorectomy; our detection of an association cannot be interpreted as evidence of causation. We used employment as a proxy for prescription drug coverage because outpatient pharmaceutical prescriptions are excluded from universal health care in Canada and instead often covered in employer-sponsored health benefits.…”

The long-term association between bilateral oophorectomy and depression: a prospective cohort study

“…16,[41][42][43] These changes in sex steroids may potentially impact on mood and may contribute to higher rates of depression following postmenopausal oophorectomy; however, it is not possible to differentiate the effects of reduced estrogens and reduced androgens in these circumstances. Other factors affecting the associations between bilateral oophorectomy at older ages and depression could include that the indication for surgery is more likely to be for cancer, 44 or that with increasing age there is a higher likelihood of comorbidities and increased physical function limitations that may be differentially higher in women with oophorectomy 45,46 that may in turn impact depression risk. Finally, rates of depression may be higher in women in midlife who experience major sociopsychological changes relating to changes in social and working status, family rearrangements or exposure to stressful events.…”