Rates Of Laparoscopic Hysterectomy Research Articles

7754 The Impact of Physician Remuneration Incentive on Laparoscopic Hysterectomy Practice in Canada: An Interrupted Time Series Analysis

<h3>Study Objective</h3> To determine whether the introduction of a physician remuneration incentive within certain Canadian provinces resulted in increased practice of laparoscopic hysterectomy over time. <h3>Design</h3> Retrospective population-based study with interrupted time series analysis of federal health administrative data from the Canadian Institute for Health Information <h3>Setting</h3> Hospitals in all the provinces of Canada, excluding territories <h3>Patients or Participants</h3> 81,507 patients aged ≥18 years undergoing hysterectomy for benign gynecologic indication in Canada from 2006/07 to 2016/17 <h3>Interventions</h3> Hysterectomy <h3>Measurements and Main Results</h3> Reviewof physician remuneration fee schedules for each province in Canada identified three provinces where a physician incentive (additional 25-50% remuneration) was introduced: British Columbia (BC) (2013), Saskatchewan (SK) (2012), and Prince Edward Island (PEI) (2011). During the 10-year period, the rates of laparoscopic hysterectomy increased rapidly in BC (6.0%-54.7%), SK (13.5%-66.7%), and PEI (<1.0%-36.9%) (<i>p</i><0.05 for all trends). In SK (n=7,857 hysterectomies), there was a significant additional increase in the rate of laparoscopic hysterectomy from 40.6% to 49.4% in the quarter following the incentive (<i>p</i><0.0001). In BC (n=16,332), there was no significant additional increase in the rate of laparoscopic surgeries after the introduction of a financial incentive. Though PEI appeared to demonstrate an increase in the rate of laparoscopic hysterectomy following the incentive, ITS analyses were not performed due to the small sample size (n=2,583). <h3>Conclusion</h3> The introduction of physician remuneration incentive appears to be associated with an increase in practice of laparoscopic hysterectomy in some provinces but not others. While physician incentive may help encourage minimally invasive surgical practice, the effects are likely modified by other important factors, such as operating room resources and training opportunities.

Trends and Perioperative Outcomes across Elective Benign Hysterectomy Procedures from the ACS-NSQIP 2007-2017

Study Objective To delineate long-term national trends in the frequency of hysterectomy surgical routes, patient demographics, and perioperative morbidity with emphasis on extended length of stay and readmission rates. Design This retrospective cohort study evaluated 224,357 patients who underwent benign hysterectomy between 2007-2017. Setting In-patient hysterectomies performed at one of the participating hospitals in the American College of Surgeons- National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients or Participants The ASC-NSQIP database was used to recognize patients who underwent an elective benign hysterectomy between 2007-2017. Patients were identified using Current Procedural Terminology (CPT) and International Classification of Disease (ICD) codes. Interventions Laparoscopic, transvaginal, and abdominal hysterectomy for benign indications. Measurements and Main Results Summary statistics were used to evaluate shifts in patient characteristics and postoperative outcomes by hysterectomy route and year of surgery. Multivariable logistic regression analysis comparing laparoscopic to transvaginal and abdominal hysterectomies was performed, adjusting for patient characteristics and operative time. Variables of interest included age, Body Mass Index (BMI), American Society of Anesthesiologists (ASA) classification, uterine weight > 250 grams, Extended Length Of Stay (ELOS) and readmission. Our data shows that the rate of laparoscopic hysterectomy increased by more than 200% between 2007-2017 while that of transvaginal and abdominal hysterectomies decreased. Moreover, the mean age and rates of obesity amongst women undergoing hysterectomy increased steadily across all surgical routes, the sharpest increase in obesity noted amongst the laparoscopic hysterectomy group. In 2011, we noted a shift in the laparoscopic hysterectomy group, which by 2017, had 29% lower odds of ELOS as compared to the abdominal group (P Conclusion Although the benign surgical gynecology patient population is becoming increasingly complex, the risk of complications after hysterectomy is lowest when performed laparoscopically.

Racial Disparities in Hysterectomy Route for Benign Disease: Examining Trends from 2007-2018 Using the NSQIP Database

Study Objective To examine national trends among race/ethnicity and route of benign hysterectomy from 2007-2018. Design This cohort study from 2007-2018 was conducted using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database and included the 2014-2018 targeted hysterectomy files. Setting NSQIP is a nationally validated, outcomes-based program containing perioperative data. Patients or Participants Current Procedural Terminology codes identified women undergoing benign hysterectomy and perioperative data including race and ethnicity were obtained. To determine relative trends in hysterectomy among racial cohorts (White, Black, Other) and ethnicity cohorts (Hispanic, Non-hispanic), we examined the proportion of each procedure performed annually compared to the others in the same category. Interventions N/A Measurements and Main Results From 2007 to 2018, 322,834 hysterectomies were collected (216,413 White, 46,248 Black, 60,173 Other; and 33,881 Hispanic). From 2007 to 2018, rates of laparoscopic hysterectomy increased in all cohorts (29% to 71% for White, 23% to 56% for Black, 16% to 60% for Other; and 20% to 64% for Hispanic; ptrend Conclusion As compared to White women, black women are less likely to undergo benign hysterectomy via a minimally invasive approach. Black women are more likely to have larger uteri and comorbid conditions which may attribute to higher rates of abdominal hysterectomy. Higher prevalence of abdominal hysterectomy among younger Black women highlights potential racial disparities in women's healthcare.

Preferred and actual methods of hysterectomy: A survey of current practices among members of the South African Society of Obstetricians and Gynaecologists

Background. Hysterectomy remains one of the most common operative procedures for benign uterine diseases. Total abdominal hysterectomy (TAH) constitutes the most common approach despite the advantages of minimally invasive hysterectomy (MIH). Objectives. To explore the current opinion on hysterectomy choices amongst members of the South African Society of Obstetricians and Gynaecologists (SASOG), as well as the perceptions and potential barriers that may inhibit gynaecologists from offering MIH to their patients. Methodology. An anonymous survey designed to explore the preferences of practising obstetrician gynaecologists regarding the optimal hysterectomy procedure, and perceived barriers towards MIH. Results. The average age of the respondents ( N =152) was 45.7 years, with 88.2% having &gt;5 years’ experience in private practice. When asked about the preferred route of hysterectomy for themselves or their relatives, 46.2% chose vaginal hysterectomy (VH), 25.4% chose total laparoscopic hysterectomy (TLH), 15% chose laparoscopic assisted vaginal hysterectomy (LAVH) and 8.5% chose TAH. However, the most commonly performed hysterectomy procedure undertaken by the respondents in the last year was TAH. Only half of the respondents wished to increase their rate of VH and a lesser number to extend their laparoscopic hysterectomy rates. Conclusion. Although the majority of the respondents preferred the minimally-invasive VH or TLH for themselves or their relatives, TAH remains the most common hysterectomy method among SA gynaecologists. This difference could present an ethical dilemma for the gynaecologist. The desire of a minority to change their approach to VH indicates the difficulty in changing attitudes and the need to promote VH as a technique within SASOG.

Increasing the Rate of Laparoscopic Hysterectomy Safely for Benign Gynecologic Disease

Objective: Complication rates during laparoscopic hysterectomy performed at high-volume surgical centers have not been reviewed recently; rather, reliance is placed on older data when counseling pa...

Vaginal or laparoscopic hysterectomy: Do perioperative outcomes differ? A propensity score-matched analysis.

There are assertions that vaginal mode may be the preferred approach of minimally invasive hysterectomy, yet rates of laparoscopic hysterectomy (LH) continue to rise while vaginal hysterectomy (VH) rate remains relatively unchanged. The aim of this study is to compare the perioperative outcomes of LH vs VH. We identified women who underwent either LH or VH for benign indications between 2009 and 2015 at a large academic institution. A propensity score-matched analysis was used to adjust for differences between women undergoing VH vs LH. Outcome parameters were perioperative complications (both intraoperative and postoperative), operative time, blood loss, hospital length of stay, conversion and readmission. A total of 1921 patients underwent either LH or VH during the study period. In all, 155 patients from each group were successfully matched using propensity score match analysis. While most intra- and postoperative characteristics did not differ between groups, LH was associated with lower blood loss during surgery (102.8±166.5mL vs 185.0±179.0mL, P<0.001) and shorter hospital stay (0.9±1days vs 1.2±0.9days, P<0.0001). Concomitant adnexal surgery was performed more frequently during LH (47.7% vs 12.3%, P<0.0001), and concomitant prolapse surgery was performed more frequently at the time of VH (14.2% vs 68.4%, P<0.0001). Both VH and LH have overall favorable perioperative outcomes; however, LH is associated with lower blood loss and a shorter hospital stay. The results support the trend toward increasing rates of laparoscopic approach to hysterectomy when appropriate.

A Favorability Score for Vaginal Hysterectomy in a Statewide Collaborative

Study ObjectiveBecause it is associated with fewer complications and more rapid recovery, the vaginal approach is preferred for benign hysterectomy. Patient characteristics that traditionally favor a vaginal approach include adequate vaginal access, small uterine size, and low suspicion for extrauterine disease. However, the low proportion of hysterectomies performed vaginally in the United States suggests that these data are not routinely applied in clinical practice. We sought to analyze the association of parity, prior pelvic surgery, and uterine weight with the use of the vaginal, laparoscopic, robotic, and abdominal approaches to hysterectomy. DesignA retrospective cohort study (Canadian Task Force classification II-2). SettingThe Michigan Surgical Quality Collaborative is a statewide organization of 52 academic and community hospitals in Michigan funded by Blue Cross and Blue Shield of Michigan/Blue Care Network, including patients from all insurance payers. PatientsFive thousand six hundred eight women undergoing hysterectomy for benign gynecologic conditions from January 1, 2013, through December 8, 2013, and included in the Michigan Surgical Quality Collaborative. InterventionsTo assess potential for vaginal hysterectomy, a favorability score of 0, 1, 2, or 3 was calculated by summing 1 point each for parity ≥1, no prior pelvic surgery, and uterine weight <250 g. Frequencies of surgical approaches to hysterectomy were compared using chi-square tests across favorability scores. Measurements and Main ResultsThe use of robotic hysterectomy was most frequent (41.9%, n = 2349/5608) followed by abdominal (19.7%, n = 1103/5608), laparoscopic (14.4%, n = 809/5608), vaginal (13.5%, n = 758/5608), and laparoscopic-assisted vaginal (10.5%, n = 589/5608) hysterectomy. With favorability scores of 0, 1, 2, and 3, vaginal hysterectomy was performed in 0.6% (n = 1/167), 5% (n = 66/1324), 13.7% (n = 415/3036), and 25.5% (n = 276/1081) of cases and abdominal hysterectomy in 41.9% (n = 70/167), 30.8% (n = 408/1324), 17.5% (n = 531/3036), and 8.7% (n = 94/1081), respectively. There was little variation in the rates of laparoscopic hysterectomy (13.3%–16.8%, p = .429) and robotic hysterectomy (39.5%–42.4%, p = .518) across favorability scores. ConclusionIn a population of women undergoing hysterectomy in the state of Michigan, the use of vaginal and abdominal hysterectomy varied with respect to parity, prior pelvic surgery, and uterine weight, but there was little variation in the use of laparoscopic and robotic approaches. The favorability score could potentially be used as a quality improvement tool to evaluate practice patterns with respect to the use of various surgical approaches to hysterectomy.

Minimally invasive specialists and rates of laparoscopic hysterectomy.

Background and Objective:Despite the prevalence of hysterectomy for treatment of benign gynecologic conditions, providers nationwide have been slow to adopt minimally-invasive surgical techniques. Our objective is to investigate the impact of a department for minimally invasive gynecologic surgery (MIGS) on the rate of laparoscopic hysterectomy at an academic community hospital without robotic technology.Methods:This retrospective observational study included all patients who underwent hysterectomy for benign indications from January 1, 2004, through December 31, 2012. The primary outcome was route of hysterectomy: open, laparoscopic, or vaginal. Secondary outcomes of interest included length of stay and factors associated with an open procedure.Results:In 2004, only 24 (8%) of the 292 hysterectomies performed for benign conditions at Newton-Wellesley Hospital (NWH) were laparoscopic. The rate increased to more than 50% (189/365) by 2008, and, in 2012, 72% (316/439) of hysterectomies were performed via a traditional laparoscopic approach. By 2012, more than 93% (411/439) of all hysterectomies were performed in a minimally invasive manner (including total laparoscopic hysterectomy [TLH], laparoscopic supracervical hysterectomy [LSH], total vaginal hysterectomy [TVH], and laparoscopy-assisted vaginal hysterectomy [LAVH]). More than 85% of the hysterectomies at NWH in 2012 were outpatient procedures. By this time, the surgeon's preference or lack of expertise was rarely cited as a factor leading to open hysterectomy.Conclusions:A large diverse gynecologic surgery department transformed surgical practice from primarily open hysterectomy to a majority (>72%) performed via the traditional laparoscopic route and a large majority (>93%) performed in a minimally invasive manner in less than 8 years, without the use of robotic technology. This paradigm shift was fueled by patient demand and by MIGS department surgical mentorship for generalist obstetrician/gynecologists.

Evidence-based implementation and increase in the rate of laparoscopic hysterectomy.

Evidence-based implementation and increase in the rate of laparoscopic hysterectomy.

Impact of a Minimally-Invasive Gynecologic Surgery Department on Rates of Laparoscopic Hysterectomy: 2004 to 2012

Impact of a Minimally-Invasive Gynecologic Surgery Department on Rates of Laparoscopic Hysterectomy: 2004 to 2012

Robotically Assisted vs Laparoscopic Hysterectomy Among Women With Benign Gynecologic Disease

There has been increasing enthusiasm for robotic gynecologic surgery in recent years. Most data supporting robotically assisted hysterectomy for benign gynecologic disease were from small studies conducted in single institutions or centers with surgery performed by highly experienced surgeons. The results of these studies may not be applicable to the practice of gynecology in a community setting. A meta-analysis of randomized trials comparing robotic and laparoscopic surgery for benign gynecologic disease concluded that both procedures were associated with similar outcomes and complications; however, the robotic procedure was considerably more expensive. At present, benefits of robotically assisted hysterectomy for women with benign gynecologic disease are unclear. The aims of this population-based study were to determine rates of uptake of robotically assisted hysterectomy over a 3-year period and to compare the association between use of robotic surgery and rates of abdominal and laparoscopic hysterectomy during this period. In-hospital complications and costs were also compared. The cohort was composed of 264,758 women who underwent hysterectomy for benign gynecologic disorders at 441 hospitals in the United States from 2007 to 2010. The primary outcome measures were uptake of robotic-assisted hysterectomy and factors associated with its utilization. Factors evaluated in the participants included complications, transfusion, reoperation, length of stay, death, and cost. A propensity score–matched analysis was performed to analyze outcomes and minimize selection bias and to estimate the propensity to undergo a robotic-assisted hysterectomy. Uptake of robotically assisted hysterectomy increased rapidly over the 3-year study period from 0.5% to 9.5% of all hysterectomies. Laparoscopic hysterectomy rates during this same time period increased from 24.3% to 30.5%. At hospitals where the robotic procedure was used starting in 2007, it accounted for 22.4% of all hysterectomies by 2010. Increased uptake of robotic-assisted hysterectomy was paralleled by a decrease in the rate of abdominal hysterectomy both in hospitals where robotic-assisted hysterectomy was performed and in those where it was not performed. Propensity score–matched analysis showed similar complication rates for robotic-assisted and laparoscopic hysterectomy (5.5% vs 5.3%); relative risk [RR] was 1.03, with a 95% confidence interval (CI) of 0.86 to 1.24. Hospitalization for longer than 2 days was significantly less common in patients who underwent robotic-assisted hysterectomy compared with the laparoscopic hysterectomy cohort (19.6 vs 24.9%, P < 0.001), whereas there was no difference in the rate of transfusion (1.4% vs 1.8%; RR, 0.80; 95% CI, 0.55–1.16) or the rate of discharge to a nursing facility (0.2% vs 0.3%; RR, 0.79; 95% CI, 0.35–1.76; P > 0.05 for both comparisons). The total costs of robotically assisted hysterectomy per case was more than for laparoscopic hysterectomy; the difference was $2189 (95% CI, $2030–$2349). These data show that the uptake of robotically assisted hysterectomy for benign gynecologic disorders increased substantially between 2007 and 2010. The morbidity profiles for robotically assisted and laparoscopic hysterectomy were similar, but the cost of the robotic procedure was substantially higher.