Trends in Mode of Gynecologic Surgery for Benign Disease in Brazil

Abstract

Objective:

There are limited studies on laparoscopy for benign hysterectomy in low- and middle-income countries. This article describes national trends in modes of hysterectomy in Brazil and compares outcomes by regions and health sectors.

Materials and Methods:

This was a cross sectional retrospective analysis of benign hysterectomies from open-access national databases (public sector: 2008–2017; private sector: 2016) in Brazil. Variables examined included the modes (vaginal, abdominal, and laparoscopic) of hysterectomies, geographic regions, mortality rates, and lengths of stay (LOS).

Results:

Benign hysterectomies decreased by 19.2% over 10 years. The proportion of abdominal surgeries increased from 85% to 88%. Despite an increase in laparoscopic surgeries (0.2–0.9%), minimally invasive surgery (vaginal and laparoscopic) decreased (14.7%–12.6%), largely driven by a drop in vaginal cases (14.5%–11.7%). More laparoscopic hysterectomies were performed in the private sector compared to the public sector (11% versus 1%; p < 0.001). There were significant geographic disparities, with 17% of hysterectomies in the private sector performed laparoscopically in the south compared to 9% in the northeast (p < 0.001).

Conclusions:

Trends in modes of hysterectomies have changed. There are regional inequities, with wealthier regions accessing more laparoscopic surgery. Understanding the trends and factors affecting access to laparoscopy is essential for ensuring equitable access to high-quality gynecologic care. (J GYNECOL SURG 37:337)