Impact of power morcellator removal on hysterectomy practice patterns

Abstract

ObjectiveThis study was a quality improvement project investigating patterns of hysterectomy practice including changes in surgical techniques and patient outcomes after manufacturer withdrawal of a laparoscopic power morcellator from our hospitals in July 2014. Study designThis time-series pre and post retrospective review examined data from electronic health records, comparing one year when a laparoscopic power morcellator was available (Year 1, mid-2013 to mid-2014) to one year after withdrawal (Year 2, mid-2014 to mid-2015). Data were from patients of 8 gynecologists in a multispecialty group associated with a large, integrated care and coverage delivery system in Washington State. Analyzed were 100 patients for Year 1 and 133 patients for Year 2. Analysis was by two-sided chi-square tests comparing practice patterns and outcomes in the two years. ResultsFor hysterectomy route, no significant difference was seen between Years 1 and 2 in percent surgeries that were abdominal or laparoscopic (including robotic). For minimally invasive hysterectomies, significantly more transvaginal hysterectomies were performed in Year 2 (22%) than Year 1 (14%) (p<0.05). In Year 2, no laparoscopic supracervical hysterectomies occurred, with total laparoscopic or vaginal hysterectomies performed instead. Transvaginal uterus morcellation increased from 13% in Year 1 to 24% in Year 2 (p<0.05). Bilateral salpingectomies increased in Year 2 as well (p<0.05). Among patient factors, estimated blood loss, surgical site infection, total operative time, and hospital length of stay were not significantly different between Years 1 and 2. Body mass index, race/ethnicity, and age did not differ between years. No patients had occult uterine sarcoma. ConclusionSurgical practice patterns changed for our group of 8 gynecologists in the year after a laparoscopic power morcellator was withdrawn. Though open hysterectomies did not increase, no laparoscopic supracervical hysterectomies were performed. Total laparoscopic and vaginal hysterectomies and bilateral salpingectomies increased, with reliance on transvaginal uterine tissue-removal techniques. Patient outcomes including surgical infections, length of surgery, estimated blood loss and total hospital stay did not change. Our results suggest that experienced vaginal surgeons can adapt to removal of important surgical equipment and continue to provide minimally invasive hysterectomies without compromising patient outcomes and safety.