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

STUDY 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.

The origins and outcomes of triplet and quadruplet pregnancies in Nova Scotia: 1980 to 2001.

The objective of this study was to determine the rate, origin, maternal and perinatal outcomes, and the associated hospital costs of higher order multiple births in one Canadian province. All higher order multiple pregnancies (triplets and above) in Nova Scotia over a 22-year period (1980 to 2001) were reviewed, and the maternal and perinatal outcomes and hospital costs were compared with singletons and twins in the same hospital population. During the 22-year period, 116,785 infants were delivered, including 3448 twins, 99 triplets, and 16 quadruplets. Of the higher order multiple gestations, 51.4% were conceived through infertility therapy. When compared with mothers of either singletons or twins, mothers of higher order gestations were significantly older, had longer antepartum and postpartum hospital stays, were more likely to have cesarean delivery, preterm labor, preeclampsia, and require intensive care unit admission. Triplets and quadruplets had significantly higher rates of preterm delivery, major anomalies, neonatal intensive care, respiratory distress syndrome, intrauterine growth restriction, serious morbidity, 5-minute Apgar scores < or = 3, and neonatal death than twins or singletons. The estimated hospital costs for this population ranged from 6,750 US dollars for a singleton pregnancy to 278,400 US dollars for a quadruplet pregnancy. Maternal morbidity, perinatal morbidity and mortality, and hospital costs are significantly increased in higher order births compared with both twins and singletons.