General Gynecology · Clinical Practice
Abstract
Objective
The objective of our study was to provide a contemporary description of hysterectomy practice and temporal trends in Canada.
Design
A national whole-population retrospective analysis of data from the Canadian Institute for Health Information.
Setting
Canada.
Patients
All women who underwent hysterectomy for benign indication from April 1, 2007, to March 31, 2017, in Canada.
Interventions
Hysterectomy.
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. Using Ontario as the comparator, Nova Scotia (aRR 1.35; 95% CI, 1.27-1.43), New Brunswick (aRR 1.25; 95% CI, 1.18-1.32]), Manitoba (aRR 1.35; 95% CI, 1.28-1.43), and Newfoundland and Labrador (aRR 1.18; 95% CI, 1.10-1.27) had significantly higher risks of abdominal hysterectomy. In contrast, Saskatchewan (aRR 0.75; 95% CI, 0.74-0.77) and British Columbia (aRR 0.86; 95% CI, 0.85-0.88) had significantly lower risks, whereas Prince Edward Island, Quebec, and Alberta were not significantly different.
Conclusion
The proportion of minimally invasive hysterectomies for benign indication has increased significantly in Canada. The declining use of vaginal approaches and the variation among provinces are of concern and necessitate further study.
Topics
By this author
Mid-Cycle Pain in Endometriosis: Clinical Correlations and Potential Etiological Factors
Rojas HE et al., 2026 · Journal of women's health (2002)
To characterize differences between individuals with and without mid-cycle pain in a registry cohort with endometriosis. Prospective analysis of data from the Endometriosis Pelvic Pain Interdisciplinary Cohort Data Registry (Clinicaltrials.gov #NCT02911090) at a tertiary referral center in Western Canada. Three hundred forty-five individuals aged 18-49 years who: (1) had at least one episode of menstrual bleeding in the last 3 months, (2) attended a baseline initial visit, and (3) subsequently had surgery with histological confirmation of endometriosis between January 2018 and December 2023. Exclusion criteria included (1) previous hysterectomy; (2) hormonal suppressive therapy use in the last 3 months; and (3) missing data on mid-cycle pain, history of hormonal therapy use, or menstrual cycle regularity. N/A. Mid-cycle pain in the last month versus No mid-cycle pain in the last month. Of the 345 participants, 67% (n = 232) reported mid-cycle pain in the last month. Mid-cycle pain in the last month was significantly associated with higher mean Central Sensitization Inventory score (48 ± 17 versus 36 ± 16, p < 0.001) and more months of prior hormonal suppressive therapy use (58 [14-120] versus 26 [0-109], p = 0.012). Abnormal anatomy at the time of surgery (e.g., endometrioma, ovarian adhesions) was not associated with mid-cycle pain in the last month. In this endometriosis cohort at a tertiary referral center, most participants reported mid-cycle pain in the last month, which was associated with central sensitization but was not clearly related to endometriosis anatomical distortion.
Medical Management · Pain Management
Guideline No. 468: Clinical Management of Endometriosis
Yong PJ et al., 2026 · Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC
To provide health care professionals with an evidence-based approach to the management of endometriosis and its associated symptoms. Women and gender-diverse individuals affected by endometriosis. BENEFITS, HARMS, Timely and effective management of endometriosis has the potential to reduce pain, improve fertility and quality of life, and enhance long-term health outcomes. Early intervention may also help mitigate the financial and health system burdens associated with delayed diagnosis and treatment. Published literature was retrieved through searches of PubMed, Ovid, Medline, Embase, Scopus, and the Cochrane Library from August 2010 through December 2025, using relevant MeSH heading and keywords. Results were restricted to systematic reviews, meta-analyses, randomized controlled trials/controlled clinical trials, observational studies, and clinical practice guidelines. Results were limited to English or French language materials. Evidence was supplemented with references from the 2010 Society of Obstetricians and Gynaecologists of Canada guideline No. 244. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional recommendations). Health care providers involved in the care of individuals with endometriosis. Early identification and management of endometriosis can significantly improve patient outcomes, reduce long-term health care costs and improve their quality of life. RECOMMENDATIONS.
Pelvic Pain · Chronic Pelvic Pain
Endometriosis Pain Index: development of a model to predict poor pain-related quality of life after endometriosis surgery through machine learning analysis of registry data
Tucker DR et al., 2026 · Pain · Free to read
Predictive tools are lacking for pain-related outcomes after endometriosis surgery. The objective of this study was to develop and validate a machine learning-based clinical model to predict poor pain-related quality of life after endometriosis surgery. Registry data from a prospective longitudinal cohort at a tertiary referral center (2013-2020) was used for model development and validation. Participants underwent an index endometriosis surgery, and completed the pain subscale of the Endometriosis Health Profile-30 (EHP-30) at baseline and 1-2-year follow-up. The outcome was poor pain-related quality of life defined as EHP-30 pain subscale above the 75th percentile for North America, at 1 to 2 years postsurgery. Thirty-two preoperative factors were evaluated, with final models retaining the top 10 most important predictors. Elastic net logistic regression, random forest (RF) and multilayer perceptron neural network models were developed. Internal validation was performed using 500 bootstrap samples, and a held-out test cohort. The study included 650 488 in the training cohort and 162 in a held-out test cohort. The RF model exhibited the most consistent discrimination, measured by the area under the receiver operating characteristic curve, between the training cohort (0.768; 95% CI: 0.690-0.837) and test cohort (0.766; 95% CI: 0.676-0.863, Δ = -0.002). The RF model also demonstrated the best integrated calibration index (0.029) and highest net benefit. Final preoperative predictors for the RF model included baseline EHP-30 score, surgery type (conservative fertility-sparing vs hysterectomy), anxiety scores, depression scores, pain catastrophizing scale scores, abdominal wall pain, pelvic floor myalgia, smoking status, back pain, and race/ethnicity. We present the RF model as the Endometriosis Pain Index to aid preoperative counselling for endometriosis surgery.
Pelvic Pain · Chronic Pelvic Pain
Endometriosis, symptoms, and risk for depression and/or anxiety: a population-based retrospective study
Goodwin E et al., 2025 · BMC women's health · Free full text on PubMed Central
Endometriosis is a chronic and inflammatory condition that often presents with chronic pelvic pain, dysmenorrhea, and dyspareunia, thus having important effects on quality of life. There are two proposed hypotheses to describe the known association between endometriosis and depression and anxiety: (1) the disease hypothesis, where the inflammatory nature of endometriosis is driving increased risk for depression and anxiety; and (2) the pain hypothesis, where it is the painful symptoms underlying the increased risk. We aimed to shed further light on these two hypotheses by assessing the risk for depression and/or anxiety in three groups of patients pathologically assessed for endometriosis: symptomatic endometriosis patients (Symp Endo), symptomatic patients with no pathological endometriosis diagnosis (Symp No Endo), and asymptomatic endometriosis patients (Asymp Endo). This study included pathologically-confirmed endometriosis patients identified from the pathology records of Vancouver Coastal Health Authority between 2000 and 2008. These data were linked with population-based administrative health data for follow-up to 2017. Depression and anxiety were identified through diagnostics codes from health services use data and prescriptions for antidepressants. Bivariate analyses were performed to assess differences between groups. Cox proportional hazards models were run to generate hazard ratios for incident depression and/or anxiety between the groups. There were 2729 people in Symp Endo, 585 in Symp No Endo, and 326 in Asymp Endo. Symp No Endo was more likely than Symp Endo to be visiting a physician for pelvic pain and to be taking prescription-level pain medications (p < 0.001). After adjusting for several covariates, Symp No Endo had a significantly higher risk of incident depression and/or anxiety (adjusted HR: 1.23, 95% CI: 1.06-1.41) compared to Symp Endo. There was no statistically significant difference in risk of depression and/or anxiety between Symp Endo and Asymp Endo (adjusted HR: 0.94, 95% CI: 0.76-1.17). These results point toward the pain focused hypotheses as Symp No Endo patients were at higher risk for depression/anxiety than the Symp Endo group. However, the results also suggest the disease hypothesis is at play, because the Symp Endo and Asymp Endo groups were at the same level of risk for depression/anxiety.
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Clinical Practice · Practice Patterns
Hysterectomy trends for benign indications over a 15-year period in an academic teaching center in Poland: a retrospective cohort study
Romanek-Piva K et al., 2016 · Ginekologia polska · Free to read
The aim of the study was to evaluate changes in the operative trends for various types of hysterectomy due to benign indications, between 2001 and 2015, at the 2nd Department of Gynecology, Medical University of Lublin, as compared to the National Health Service (NHS) registry in Poland. A retrospective cohort study was conducted. Data from the Internal Hospital Discharge Registry and Pathological Results Registry have been compared to the NHS database, which has been available nationwide since 2009. The study group included 5629 women who underwent hysterectomy due to benign indications. During the study period, the following number of procedures were performed: total abdominal hysterectomy - 344 (6.11%), total abdominal hysterectomy with bilateral salpingo-oophorectomy - 1760 (31.27%), total vaginal hysterectomy - 563 (10.00%), subtotal abdominal hysterectomy - 2536 (45.05%), and laparoscopically-assisted subtotal hysterectomy (LASH) - 426 (7.57%). The abdominal route, with the preference for subtotal abdominal hysterectomy, was the main approach to hysterectomy. Symptomatic fibroids were the most common indication for the procedure. Comparison of data collected over the last five years revealed a significant difference in the approach to hysterectomy in favor of subtotal abdominal hysterectomy (SAH) and LASH. Less invasive techniques of hysterectomy (LASH, SAH), which are the preferred choice at the 2nd Department of Gynecology (Lublin), are safe and effective options of treating benign conditions. We are of the opinion that these ap-proaches should be offered to patients instead of more radical techniques. Proper training of physicians may influence the decision-making process in favor of minimally invasive techniques.
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 et al., 2014 · CMAJ open · Free full text on PubMed Central
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. 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. 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. 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.
Nationwide trends in the performance of inpatient hysterectomy in the United States
Wright JD et al., 2013 · Obstetrics and gynecology · Free full text on PubMed Central
To examine the use of inpatient hysterectomy and explore changes in the use of various routes of hysterectomy and patterns of referral. The Nationwide Inpatient Sample was used to identify all women aged 18 years or older who underwent inpatient hysterectomy between 1998 and 2010. Weighted estimates of national trends were calculated and the number of procedures performed estimated. Trends in hospital volume and across hospital characteristics were examined. After weighting, we identified a total 7,438,452 women who underwent inpatient hysterectomy between 1998 and 2010. The number of hysterectomies performed annually rose from 543,812 in 1998 to a peak of 681,234 in 2002; it then declined consistently annually and reached 433,621 cases in 2010. Overall, 247,973 (36.4%) fewer hysterectomies were performed in 2010 compared with 2002. From 2002 to 2010 the number of hysterectomies performed for each of the following indications declined: leiomyoma (-47.6%), abnormal bleeding (-28.9%), benign ovarian mass (-63.1%), endometriosis (-65.3%), and pelvic organ prolapse (-39.4%). The median hospital case volume decreased from 83 procedures per year in 2002 to 50 cases per year in 2010 (P<.001). The number of inpatient hysterectomies performed in the United States has declined substantially over the past decade. The median number of hysterectomies per hospital has declined likewise by more than 40%. III.
Uterine Surgery · Myomectomy
Laparoscopic versus abdominal myomectomy: practice patterns and health care use in British Columbia
Chen I et al., 2014 · Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC
To examine the relative frequency and surgical outcomes of laparoscopic myomectomy compared with abdominal myomectomy in British Columbia. A linked database containing hospital admission, operating room, and emergency room data from 2007 to 2011 from eight Vancouver Coastal Health and Providence Health Region hospitals in British Columbia was used to conduct a retrospective cohort study of women who had myomectomy for uterine fibroids. All consecutive women who had abdominal or laparoscopic myomectomy at five hospitals were included in the study. Patients who had submucosal fibroids or hysteroscopic procedures were excluded. Abdominal and laparoscopic myomectomies were contrasted in terms of patient characteristics and surgical outcomes. Statistical significance was assessed using t tests, Wilcoxon, chi-square, and Fisher exact test; a two-sided P value < 0.05 was considered significant. Of eight hospitals offering gynaecologic surgery, myomectomies were performed at five hospitals located in metropolitan areas. Of 436 women undergoing myomectomy, 88 cases (20.2%) were laparoscopic, 342 (78.4%) were abdominal, and 6 (1.38%) were laparoscopic with conversion to laparotomy. Women who had laparoscopic rather than abdominal myomectomies were slightly older (mean 38.7 vs. 37.4 years, respectively, P < 0.05). No significant difference was observed in median operative time (106 vs. 95 min), but length of stay was decreased for laparoscopic myomectomies (median 1 vs. 2 days, P < 0.01). No significant differences were observed between laparoscopic and abdominal routes in the rates of admission to intensive care, prolonged hospitalization (> 3 days), or rehospitalization. Myomectomies are performed in urban, metropolitan areas in British Columbia, and a significant fraction of myomectomies are performed by laparoscopy. Compared with abdominal myomectomies, laparoscopic myomectomies in pre-selected patients are associated with decreased length of stay and comparable perioperative surgical outcomes.
General Gynecology › Clinical Practice › Practice Patterns
Ranjeeta Mallick, Catherine Allaire, Krisztina I Bajzak, Liane M Belland, Krista A Cassell, Abdul Jamil Choudhry, Geoffrey W Cundiff, Jamie Kroft, Sarah Maheux-Lacroix, Chandrew Rajakumar, Elizabeth Randle, Deborah Robertson, John A Thiel, Togas Tulandi
R Mallick, Cathy Allaire, Kate Allaire, C Allaire, K Bajzak, L Belland, K Cassell, A Choudhry, G Cundiff, J Kroft, S Maheux-Lacroix, C Rajakumar, Liz Randle, Beth Randle, Betsy Randle, E Randle, Debbie Robertson, Deb Robertson, D Robertson, Jack Thiel, J Thiel, T Tulandi
PMID 33476750 33476750 DOI 10.1016/j.jmig.2021.01.010 10.1016/j.jmig.2021.01.010 Chen et al. 2021, Chen 2021