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Laparoscopic Extracorporeal Knot-Tying for Uterine Vessel Occlusion during Hysterectomy with Cervical Cerclage in Large Uteri
Published on: September 12, 2025
Socioeconomic Disparities in Surgical Wait Times for Elective Hysterectomy
Sarah Shamiya1, Nupur Dogra1, Aliya Allen-Valley2
1Department of Obstetrics & Gynecology, University of Toronto, Toronto, ON, Canada; Trillium Health Partners, Mississauga, Ontario Canada.
Objective:
To evaluate the impact of socioeconomic status (SES) on wait times for elective hysterectomy across benign and malignant indications in a public healthcare system.
Methods:
This retrospective cohort study analyzed elective hysterectomies performed between 2022 and 2024 in a Canadian hospital network serving ∼1.5 million people, where ∼70% identify as racialized. SES was defined using the 2021 Ontario Marginalization Index (ON-MARG) material resources dimension, a validated neighborhood-level indicator of deprivation. The primary outcome was wait time, defined as decision-to-treat to procedure date. Negative binomial regression assessed the relationship between SES and wait times.
Results:
Of 1498 hysterectomies, 730 were for benign and 768 for cancer indications. For benign hysterectomy, patients in the lowest SES quintile (Q5) experienced 26% longer adjusted wait times compared with the highest SES quintile (Q1) (rate ratio 1.26, 95% CI 1.10-1.45, P = 0.001). No significant wait time differences were observed for cancer-related hysterectomy between Q1 and Q5 (median 27 vs 24 days, P = 0.239).
Conclusions:
Significant SES-based disparities exist in access to benign hysterectomy within a publicly funded healthcare system. Patients from more marginalized neighborhoods experience longer waits, highlighting the need for targeted strategies to improve equity in gynecologic surgical care.