Routes of hysterectomy in women with benign uterine disease in the Vancouver Coastal Health and Providence Health Care regions: a retrospective cohort analysis

Innie Chen; Sarka Lisonkova; Catherine Allaire; Christina Williams; Paul Yong; K S Joseph

doi:10.9778/cmajo.20130080

Routes of hysterectomy in women with benign uterine disease in the Vancouver Coastal Health and Providence Health Care regions: a retrospective cohort analysis

Chen I, Lisonkova S, Allaire C, Williams C, Yong P, Joseph KS

Published October 2014 CMAJ open

DOI 10.9778/cmajo.20130080 PMID 25485254 PMC PMC4251519

RRM Academy Synopsis

Minimally invasive hysterectomy rose in two British Columbia regions

Minimally invasive hysterectomies rose from about 4 to about 5 of every 10 operations in two British Columbia health regions from 2007 to 2011. This cohort study looked back at 4372 women who had planned surgery at 8 hospitals for a benign condition. The laparoscopic share more than doubled while the abdominal and vaginal shares declined.

Key Findings

Of 4372 women, 52.3% had an abdominal, 25.5% a vaginal and 22.3% a laparoscopic hysterectomy between April 2007 and December 2011.
Minimally invasive hysterectomy rose from 41.7% to 52.3%, laparoscopic from 14.2% to 31.2%, and vaginal fell from 27.5% to 21.1% (p < 0.001 for all trends).
After adjustment, the odds of a minimally invasive approach rose 25% per year (95% CI 19%–32%). The odds of vaginal versus abdominal hysterectomy rose 12% per year (95% CI 1%–22%).
Laparoscopic versus abdominal hysterectomy had higher odds at age under 30 (adjusted OR 4.59, 95% CI 2.10–10.0, against ages 40–49) and with rural residence (1.89, 95% CI 1.28–2.78).
Laparoscopic versus abdominal hysterectomy had lower odds for fibroids as the main indication (adjusted OR 0.37, 95% CI 0.29–0.46) and for the lowest versus highest socioeconomic quintile (0.58, 95% CI 0.46–0.74).

Interpretation

Hospital records tracked each woman's age, home region, reason for surgery, income level and hospital type. These records showed the surgery route chosen for women having planned hysterectomy for benign disease in British Columbia from 2007 to 2011. The authors note that the records did not include body mass index, other health conditions, or which surgeon did the operation. The findings support larger studies of what drives the choice of hysterectomy route.

RRM Context

Fibroids (52.1%), menstrual bleeding disorders (30.3%), prolapse (22.0%) and endometriosis (21.5%) were the most common reasons for surgery. Restorative reproductive medicine looks for the cause of heavy bleeding and pelvic pain before choosing treatment. Hysterectomy ends the chance of pregnancy permanently. Excision surgery for endometriosis removes the lesions and keeps the uterus.

Our editorial summary of this paper, not the article's abstract.

Abstract

Background

Minimally invasive hysterectomies performed vaginally or laparoscopically are associated with decreased perioperative morbidity. We examined temporal trends and patient and hospital factors associated with the routes of hysterectomy used in the Vancouver Coastal Health and Providence Health Care regions in British Columbia.

Methods

We performed a retrospective cohort study of all women who had an elective hysterectomy for a benign indication between 2007 and 2011 in 8 hospitals in the region. Logistic regression modeling with mixed effects was used to estimate adjusted odds ratios and 95% confidence intervals for patient and hospital characteristics associated with the route of hysterectomy.

Results

The study involved 4372 women who underwent abdominal (52.3%), vaginal (25.5%) or laparoscopic (22.3%) hysterectomy. From 2007 to 2011, the number of abdominal hysterectomies performed decreased from 58.4% to 47.7%, the number of vaginal hysterectomies performed decreased from 27.5% to 21.1% and the number of laparoscopic hysterectomies performed increased from 14.2% to 31.2% (p < 0.001 for all trends). Patient factors associated with laparoscopic versus abdominal hysterectomy included young age, pain or prolapse indication, absence of fibroid indication, absence of concurrent gynecologic procedure, rural residence and lower socioeconomic status. Patient factors associated with vaginal hysterectomy included older age, prolapse indication and concurrent procedure for prolapse. Hospital location and size were not significantly associated with vaginal hysterectomy, but urban hospital location was associated with laparoscopic hysterectomy.

Interpretation

The proportion of minimally invasive hysterectomies is increasing and represents approximately half of all hysterectomies performed in the Vancouver Coastal Health and Providence Health Care regions. Vaginal hysterectomies are associated with patient characteristics, whereas laparoscopic hysterectomies are associated with patient and hospital characteristics.

Innie Chen, Sarka Lisonkova, Catherine Allaire, Christina Williams, Paul Yong

I Chen, S Lisonkova, Cathy Allaire, Kate Allaire, C Allaire, C Williams, P Yong

PMID 25485254 25485254 DOI 10.9778/cmajo.20130080 10.9778/cmajo.20130080 Chen et al. 2014, Chen 2014

Routes of hysterectomy in women with benign uterine disease in the Vancouver Coastal Health and Providence Health Care regions: a retrospective cohort analysis

Minimally invasive hysterectomy rose in two British Columbia regions

Key Findings

Interpretation

RRM Context

Abstract

By this author

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