Hysterectomy trends in Israel between 2005 and 2021 - A nationwide cohort

Hysterectomy remains a common gynecologic procedure worldwide, but its frequency and surgical approach vary substantially across countries and over time. We evaluated nationwide trends in hysterectomy rates, surgical approaches, and indications in Israel between 2005 and 2021.

This retrospective, population-based cohort study included all hysterectomies performed in women aged ≥15 years in Israel between 2005 and 2021. Data were extracted from the Israeli Ministry of Health database and analyzed by surgical route, indication, and patient age. National population data were used to calculate annual hysterectomy rates, and temporal trends were assessed using linear regression.

A total of 88,728 hysterectomies were performed (mean 5219 ± 277 per year, 1.8 per 1000 women annually), corresponding to a lifetime risk of 15.6%. The overall annual hysterectomy rate declined significantly (R² = 0.801, p < 0.001), primarily due to a decrease in abdominal hysterectomies (R² = 0.962, p < 0.001). Laparoscopic hysterectomies increased markedly (R² = 0.929, p < 0.001), while the use of vaginal procedures remained stable. The highest incidence was among women aged 45-54 years (4.2 per 1000), followed by those aged 65-74 years (3.6 per 1000). Laparoscopic and abdominal procedures predominated in younger women, whereas vaginal hysterectomy was most common in older age groups. Leading indications were uterine leiomyoma (29.6%), malignancy (27.7%), and pelvic organ prolapse (26.4%).

Between 2005 and 2021, hysterectomy rates in Israel declined steadily with a shift from abdominal to minimally invasive approaches, reflecting global trends within a universal healthcare system providing equitable access to gynecologic care.