Grant: Project Grant

Background: Hysterectomy is the most common surgery in non-pregnant women and among the 5 most common procedures in Canada. Women who receive hysterectomy often have important community roles as income earners and caregivers for their children or older adults. The practice of hysterectomy thus has significant societal and economic implications for Canada and its healthcare system. Alternatives to hysterectomy exist, and the use of more conservative medical and minor procedural alternatives can lead to a reduction in unnecessary surgery and complications. Social inequities exist for hysterectomy practice in Canada, and factors such as lack of awareness or inability to pay for alternative options warrant further exploration. Objectives: (1) To evaluate the variation in hysterectomy practice and use of alternative treatments in Canada; (2) To determine the effect of First Nations/Inuit/Métis status, neighbourhood income, neighbourhood education, and geographic factors on hysterectomy rate, approach, and use of alternatives; and (3) to compare healthcare utilization and cost of care for women who received alternative to hysterectomy compared with hysterectomy alone. Methods: In partnership with the Canadian Institute for Health Information, which is providing substantial in-kind support in data access and analysis, a population database analysis will be conducted of women with a common uterine condition undergoing hysterectomy or receiving an alternative treatment to examine the effects of social determinants on hysterectomy practice. In collaboration with the Society of Obstetricians and Gynaecologists of Canada, physician and patient input will be sought at all stages to ensure clinical and public relevance. Anticipated outcomes: Our study will identify subgroups of patients at highest risk of potentially avoidable procedures and has potential to lead to practice and policy changes that reduce invasive gynecologic interventions for vulnerable women in our society.