Presence of Pelvic Pain Does Not Influence Route of Benign Hysterectomy in Women Veterans

Abstract

<h3>Study Objective</h3> To determine if compared with veterans with no pelvic pain, veterans with pelvic pain undergoing hysterectomy, are more likely to have a minimally invasive hysterectomy, and whether trends in receipt of minimally invasive hysterectomy differed between those with and without pelvic pain. <h3>Design</h3> Cross-sectional study of hysterectomies performed in veterans from 2007-2014. <h3>Setting</h3> Data was obtained from the Veterans Administration (VA) Corporate Data Warehouse and included hysterectomies performed within the VA (VA provided-healthcare) and in the community and paid for by the VA (VA paid-health care). <h3>Patients or Participants</h3> All women who had hysterectomy provided or paid for by VA for a benign indication were included. Veterans who had a hysterectomy for malignancy or cesarean hysterectomy were excluded. Indications for hysterectomy were identified using ICD-9 codes; pelvic pain codes included dyspareunia, dysmenorrhea, endometriosis, and pelvic congestion syndrome. <h3>Interventions</h3> Hysterectomy was categorized as abdominal or minimally invasive (laparoscopic, robotic, and vaginal). <h3>Measurements and Main Results</h3> A total of 6,830 veterans with hysterectomies were identified: 4,540 (66.5%) had a pelvic pain, of these, 2,643 (58.2%) were abdominal and 1,897 (41.8%) were minimally invasive. Abdominal hysterectomy was used in 58.2% (n=2,643) of veterans with pelvic pain and in 60.3% (n=1,381) of veterans without pelvic pain. After adjusting for age, race, BMI, and index year of hysterectomy, there was no statistical difference in receipt of minimally invasive hysterectomy between patients with and without pelvic pain (IRR 0.99, 95% CI 0.90, 1.08). Among those undergoing hysterectomy, similar increases in the percentage of those having a minimally invasive hysterectomy for those with and without pelvic were observed between 2007 to 2014 (pelvic pain: 71.4% to 49.6%, no pelvic pain 71.3% to 53.7%). <h3>Conclusion</h3> Similar to the general population, hysterectomy rates within the VA are declining, with minimally invasive hysterectomy rates increasing. Furthermore, among veterans, the presence of pelvic pain does not appear to contribute to hysterectomy type.