Department of Obstetrics and Gynecology, University of Ottawa (Drs. Chen); Ottawa Hospital Research Institute, Ottawa, Ontario (Drs. Chen, Mallick, and Choudhry).
Ottawa Hospital Research Institute, Ottawa, Ontario (Drs. Chen, Mallick, and Choudhry).
J Minim Invasive Gynecol. 2021 May;28(5):1041-1050. doi: 10.1016/j.jmig.2021.01.010. Epub 2021 Jan 18.
The objective of our study was to provide a contemporary description of hysterectomy practice and temporal trends in Canada.
A national whole-population retrospective analysis of data from the Canadian Institute for Health Information.
Canada.
All women who underwent hysterectomy for benign indication from April 1, 2007, to March 31, 2017, in Canada.
Hysterectomy.
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.
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.
本研究旨在提供加拿大 2007 年 4 月 1 日至 2017 年 3 月 31 日期间因良性指征行子宫切除术的最新情况，并分析其时间趋势。
加拿大安大略省麦克马斯特大学健康信息研究所基于全国人口的回顾性分析。
加拿大。
2007 年 4 月 1 日至 2017 年 3 月 31 日期间因良性指征在加拿大接受子宫切除术的所有女性。
子宫切除术。
10 年间共有 369520 例女性因良性指征接受了子宫切除术，子宫切除术的发生率从每 10 万名妇女 313 例下降至 243 例。开腹子宫切除术的比例下降（59.5%至 36.9%），腹腔镜子宫切除术的比例增加（10.8%至 38.6%），阴道子宫切除术的比例下降（29.7%至 24.5%），而全国技术指数从 40.5%增加至 63.1%（p<0.001，所有趋势）。中位住院时间从 3 天（四分位距 2-4 天）减少至 2 天（四分位距 1-3 天），24 小时内出院的患者比例从 2.1%增加至 7.2%。2016-17 年，40 至 49 岁的女性行开腹子宫切除术的风险显著高于其他年龄段的女性（p<0.001）。与月经失调患者相比，因子宫内膜异位症（调整后相对风险[ARR] 1.36；95%置信区间[CI]，1.28-1.44）和子宫肌瘤（ARR 2.01；95%CI，1.94-2.08）行子宫切除术的女性行开腹子宫切除术的风险更高，而因盆腔器官脱垂和盆腔疼痛（ARR 1.47；95%CI，1.41-1.53）行子宫切除术的女性行开腹子宫切除术的风险更低。与安大略省相比，新斯科舍省（ARR 1.35；95%CI，1.27-1.43）、新不伦瑞克省（ARR 1.25；95%CI，1.18-1.32）、马尼托巴省（ARR 1.35；95%CI，1.28-1.43）和纽芬兰和拉布拉多省（ARR 1.18；95%CI，1.10-1.27）的开腹子宫切除术风险显著更高。相比之下，萨斯喀彻温省（ARR 0.75；95%CI，0.74-0.77）和不列颠哥伦比亚省（ARR 0.86；95%CI，0.85-0.88）的开腹子宫切除术风险显著更低，而爱德华王子岛、魁北克省和艾伯塔省的开腹子宫切除术风险无显著差异。
加拿大因良性指征行微创子宫切除术的比例显著增加。阴道入路使用率的下降和各省之间的差异令人关注，需要进一步研究。
