Hysterectomy Trends Research Articles

National Technicity on the Rise: Ten Year Minimally Invasive Hysterectomy Trends for Women with Benign Uterine Disease in Canada

Study Objective Hysterectomies are the most commonly performed gynecologic procedure and are associated with faster recovery and decreased complications when performed minimally invasively compared with abdominally. The objectives were to measure temporal trends in minimally invasive hysterectomy for Canada and each province/territory and to determine whether provincial/territorial differences exist. Design National population-based retrospective study using federal administrative data from the Canadian Institute for Health Information. Technicity index (proportion of vaginal and laparoscopic hysterectomies) was calculated. Cochrane-Armitage test was applied for temporal trends and 2-sided p-values Setting Canada Patients or Participants All patients undergoing hysterectomy for benign indications in Canada from FY2006/7 to FY2016/17 Interventions Hysterectomy Measurements and Main Results 369,740 hysterectomies were included (48.4% abdominal; 28.3% laparoscopic; 23.3% vaginal). Mean age was 48.5 years (SD 11.2 years), and indications for surgery were menstrual bleeding disorders (29.7%), fibroids (23.7%), pelvic organ prolapse(19.8%), other(17.4%), endometriosis(5.8%) and pelvic pain(3.6%). National technicity index (proportion of vaginal and laparoscopic hysterectomies) increased (40.5%⟶63.2%). Abdominal hysterectomy decreased (59.5%⟶36.8%); laparoscopic increased (10.8%⟶38.6%); while, vaginal decreased (29.7%⟶24.5%). (p Increasing technicity index was observed in all provinces, though with variable increase over time. (p Manitoba(36.9%⟶44.4%; RR1.50,95%CI[1.43-1.58]*), Nova Scotia(46.4%⟶48.5%; RR1.39[1.31-1.48]*), New Brunswick(43.7%⟶50.3%; RR1.34[1.26-1.44]*), Newfoundland(35.3%⟶55.2%; RR1.21[1.10-1.33]*), Ontario (39.4%⟶63.0%, RR1.00[reference])Quebec(42.0%⟶61.8%; RR1.03[0.99-1.07]), Prince Edward Island(54.9%⟶64.3%; RR0.96[0.81-1.15]), Alberta(34.0%⟶64.3%; RR0.96[0.92-1.01]), British Columbia(43.4%⟶72.1%; RR 0.75[0.71-0.79]*), Saskatchewan(47.7%⟶83.9%; RR0.44[0.39-0.49]*). Conclusion Minimally invasive hysterectomy for benign indication has increased significantly in Canada over the past decade. However, the increase reflects increasing use of laparoscopic hysterectomy with a declining use of vaginal hysterectomy. The variation between provinces represents a technicity gap that warrants further study and intervention.

Laparoscopic hysterectomy trends in challenging cases (1995–2018)

Objective: To investigate the effect of challenging factors on laparoscopic hysterectomy trends within twenty-four years. Population and Method: This was a trend analysis study of 7558 women who underwent hysterectomy for benign indications between 1995–2018 in Bursa Uludag University Hospital, Turkey. A trend analysis of obesity, previous laparotomy (≥3) and uterine specimen weight (≥500g) was applied for abdominal hysterectomy (TAH), vaginal hysterectomy (VH), and laparoscopic hysterectomy (TLH) rates in this period. The primary outcome was laparoscopic hysterectomy trends throughout the years. We measured the effect of obesity, previous laparotomies and large uterus on TLH trends as secondary outcomes. Results: The ratio of TLHs to all hysterectomies was 2.4% in 1995 and 44.7% in 2018 which increased 33 times higher over 24 years. The percentage of obese patients in TLH cases increased from 1% to 37%, the rate of patients who had three or more previous laparotomy in TLH cases increased from 0% to 32.2%, and the percentage of patients who had more than 500g uterus specimen in laparoscopic hysterectomy cases increased from 0% to 32.8%. Conclusion: Laparoscopic hysterectomy trends are increasing in challenging cases. Obesity, previous surgeries, and large uteruses are no longer a limiting factor for laparoscopic hysterectomy.

Geographic variation of hysterectomy rates in the Israeli health care system during the years 2007\u20132016

BackgroundIn 2014 the OECD published a report regarding inter-regional variation of hysterectomies in 13 countries including Israel. Variance in hospital admission rates were also reported. The Israeli Ministry of Health has set as one of its main goals the reduction in differences in health care, particularly between the country’s periphery and central regions. These variations may reflect differences in characteristics, resource allocation, and medical staff employment, expertise and training. The advances in technology in the last decades including laparoscopic and robotic surgeries and the variance in their implementation emphasize the great regional variance. The aim of this study was to examine hysterectomy trends in the past decade with emphasis on regional differences.MethodsThe study is based on information maintained by the Israeli Ministry of Health and portrays the trend in hysterectomy rates as a factor of indication, surgical approach and length of hospitalization as collected from the years 2007–2016.ResultsInter-regional significant differences were found between the 7 regions of Israel, though there was a clear trend toward a national 11–24% decrease in hysterectomy rates. A 2–4 time increase in laparoscopic hysterectomies was observed. There was a clear country-wide trend toward shortening hospital stay from 5 to 4 days in total.ConclusionsHysterectomy rates have declined in the past decade due to the implementation of new technologies allowing earlier diagnosis and minimally invasive surgery on top of offering alternative, non-surgical treatment modalities. Uneven allocation of resources and manpower allowing technology implementation and optimal medical services may have contributed to the findings.

Hysterectomy Practice Patterns in the Postmorcellation Era.

To characterize long-term national trends in surgical approach for hysterectomy after the U.S. Food and Drug Administration (FDA) warning against power morcellation for laparoscopic specimen removal. This was a descriptive study using data from the American College of Surgeons National Surgical Quality Improvement Program from 2012 to 2016. We identified hysterectomies using Current Procedural Terminology codes. We used an interrupted time-series analysis to evaluate abdominal and supracervical hysterectomy trends surrounding The Wall Street Journal article first reporting morcellation safety concerns and the FDA safety communication. We compared categorical and continuous variables using χ, t, and Wilcoxon rank sum tests. We identified 179,950 hysterectomies; laparoscopy was the most common mode of hysterectomy in every quarter. Before The Wall Street Journal article, there was no significant change in proportion of abdominal hysterectomies (0.3% decrease/quarter, P=.14). After The Wall Street Journal article, use of abdominal hysterectomy increased 1.1% per quarter for two quarters through the FDA warning (P<.001), plateaued for three quarters until March 2015 (P=.65), then decreased by 0.8% per quarter through 2016 (P<.001). Supracervical hysterectomy volume continuously decreased after the FDA warning (1.0% decrease per quarter, P<.001) and after three quarters (0.7% decrease per quarter, P=.01), then plateaued from April 2015 through 2016 (0.05% decrease per quarter, P=.40). Mode of supracervical hysterectomy was unchanged from 2012 to 2013 (P=.43), followed by two quarters of significant increase in proportion of supracervical abdominal hysterectomies (11.7%/quarter, P<.001). This change in mode of supracervical hysterectomy then plateaued through 2016 (P=.06). Despite early studies suggesting that minimally invasive hysterectomy decreased in response to safety concerns regarding power morcellation, we found that this effect reversed 1 year after the FDA safety communication. However, there was a sustained decline in supracervical hysterectomy, and the remaining supracervical hysterectomies were more likely to be performed using laparotomy.

Trends in radical hysterectomy for early-stage cervical cancer: A National Cancer Data Base study

Trends in radical hysterectomy for early-stage cervical cancer: A National Cancer Data Base study

Management of caesarean section postpartum hemorrhage

Introduction . Postpartum haemorrhage is an important cause of maternal mortality and morbidity. The most common causes are: uterine atonia, lacerations, abnormal placental adhesions and coagulopathy. Materials and method. We have reviewed international medical databases with randomized studies, meta-analyzes of current trends in postpartum hysterectomy and alternative techniques in postpartum hemorrhage. Results. The incidence of postpartum hemorrhage is 1% under a rapid therapeutic attitude. The treatment is directed to the cause. Thus, for initial uterine atony, pharmacological means and subsequent surgical gestures such as ligature of the uterine artery - O’Leary or ligature of the hypogastric artery are initiated. Sutura B-Lynch and its variants are designed to perform the compression of the uterus by mechanical force. Uterine balloons are designed to perform placental bleeding areas buffering. This is the most effective method because the catheter applies direct blood pressure to the bleeding site. Uterine bladder devices specifically designed for uterine tamponade after vaginal or caesarean birth include: Foley catheter, Bakri baloon, B-T Cath device and double-bladder device Ebb, which is also designed for cervical haemostasis. Interventional radiology requires advanced, minimally invasive management of postpartum hemorrhage. Conclusions . The use of uterotonics, pelvic vascular ligatures and balloon buffers are the first steps in the therapeutic approach to postpartum hemorrhage. Appropriate conduct consists of a pro-active attitude, often with a multidisciplinary team.

Hysterectomy trends in Australia, 2000-2001 to 2013-2014: joinpoint regression analysis.

Hysterectomy is a common gynecological procedure, particularly in middle and high income countries. The aim of this paper was to describe and examine hysterectomy trends in Australia from 2000-2001 to 2013-2014. For women aged 25 years and over, data on the number of hysterectomies performed in Australia annually were sourced from the National Hospital and Morbidity Database. Age-specific and age-standardized hysterectomy rates per 10 000 women were estimated with adjustment for hysterectomy prevalence in the population. Using joinpoint regression analysis, we estimated the average annual percentage change over the whole study period (2000-2014) and the annual percentage change for each identified trend line segment. A total of 431 162 hysterectomy procedures were performed between 2000-2001 and 2013-2014; an annual average of 30 797 procedures (for women aged 25+ years). The age-standardized hysterectomy rate, adjusted for underlying hysterectomy prevalence, decreased significantly over the whole study period [average annual percentage change -2.8%; 95% confidence interval (CI) -3.5%, -2.2%]. The trend was not linear with one joinpoint detected in 2008-2009. Between 2000-2001 and 2008-2009 there was a significant decrease in incidence (annual percentage change -4.4%; 95% CI -5.2%, -3.7%); from 2008-2009 to 2013-2014 the decrease was minimal and not significantly different from zero (annual percentage change -0.1%; 95% CI -1.7%, 1.5%). A similar change in trend was seen in all age groups. Hysterectomy rates in Australian women aged 25 years and over have declined in the first decade of the 21st century. However, in the last 5 years, rates appear to have stabilized.

Trends of Peripartum Hysterectomy in 11 years Study at Tertiary Care Hospital, KotaSuman Bala

Trends of Peripartum Hysterectomy in 11 years Study at Tertiary Care Hospital, KotaSuman Bala

Trends in hysterectomy rates among women veterans in the US Department of Veterans Affairs

Prior studies demonstrate a higher prevalence of hysterectomy among veterans compared with nonveterans. While studies identify overall decreasing hysterectomy rates in the United States, none report rates of hysterectomy among women veterans. Given the increasing numbers of women veterans using Veterans Affairs health care, there is an ongoing need to ensure high-quality gynecology care. Therefore, it is important to examine current hysterectomy trends, including proportion of minimally invasive surgeries, among veterans using Veterans Affairs health care. Our objective was to describe hysterectomy trends and utilization of minimally invasive hysterectomy in the Veterans Affairs healthcare system. This longitudinal study used Veterans Affairs clinical and administrative data from fiscal year 2008 to 2014 to identify hysterectomies provided or paid for by Veterans Affairs. Crude and age-adjusted hysterectomy rates were calculated by indication (benign or malignant), mode (abdominal, laparoscopic, vaginal, robotic assisted, unspecified), and source of care (provided vs paid for by Veterans Affairs). Mode and indication for hysterectomy were classified using International Classification of Diseases, ninth revision, codes. The distribution of hysterectomy mode in each year was calculated by indication and source of care. Between fiscal year 2008 and fiscal year 2014, the total hysterectomy rate decreased from 4.0 per 1000 to 2.6 per 1000 unique women veteran Veterans Affairs users. Age-adjusted rates of abdominal hysterectomy for benign indications decreased over the study period from 1.54 per 1000 (95% confidence interval, 1.40-1.69) to 0.77 per 1000 (95% confidence interval, 0.69-0.85) for procedures provided by Veterans Affairs and 0.77 per 1,000 (95% confidence interval, 0.69-0.85) to 0.29 per 1,000 (95% confidence interval, 0.23-0.34) for those paid for by Veterans Affairs. Among hysterectomies for benign indications provided by (n= 5296) or paid for (n= 2610) by Veterans Affairs, the percentage of hysterectomies performed abdominally decreased from 67.2% to 46.8% and from 68.9% to 57.6%, respectively. These findings suggest that gynecology care provided within Veterans Affairs has kept pace with national trends in reducing hysterectomy rates and increasing utilization of minimally invasive surgical techniques.

Trends in Hysterectomy After Cessation of Power Morcellation [19H

INTRODUCTION: In April 2014, the FDA issued a warning against use of power morcellators. Soon after, their use was banned at many hospitals, including Hartford Hospital. There have been numerous position statements for and against these bans. We sought to examine the effect of this ban on women undergoing hysterectomy at Hartford Hospital. We hypothesized a decrease in minimally invasive hysterectomy after the morcellator ban. METHODS: This was a retrospective cohort study of all women who underwent hysterectomy for benign indications at Hartford Hospital from May 2013 to April 2015. We grouped patients into those who had surgery before 5/1/14 (pre-ban) and those after 5/1/14 (post-ban). Excluded were those women undergoing hysterectomy for gynecologic malignancy or those undergoing surgery for utero-vaginal prolapse and/or incontinence. RESULTS: 1082 women met all inclusion criteria; 578 had hysterectomy pre-ban and 505 post-ban. Power morcellation decreased from 12.6% pre-ban to 0.4% post-ban, p &lt; 0.001. There was no difference in the percentage of open hysterectomies, 13.3% (77) pre-ban and 14.8% (75) post-ban, p=0.47. Supracervical hysterectomies decreased from 9.9% to 3.2% (p &lt; 0.001). There was no increase in conversion to laparotomy (2.4% vs. 1.8%, p=0.47), use of “manual morcellation” (19.3% vs. 23.8%, p=0.12) in minimally invasive procedures, mean length of stay (1.3 vs. 1.2 days, p=0.20) or blood loss (151 vs. 163 mL, p=0.69). 2 leiomyosarcomas were found, both post-ban. CONCLUSION: While we do not disagree with many of the criticisms to the FDA’s morcellator ban, it has not led to a decrease in access to minimally invasive hysterectomy at our institution.

2: Patient, surgeon, and hospital disparities associated with hysterectomy approach and perioperative complications

Hysterectomies are among one of the most common major surgical procedures performed in women. However, little is known regarding contemporary U.S. hysterectomy trends for women with benign disease with respect to both operative technique and perioperative complications. We sought to document these trends and to determine the association between these two factors with patient, surgeon, and hospital characteristics. Hysterectomies performed for benign indications by generalist gynecologists from 2012-2014 were analyzed in the all-payer Maryland Health Services Cost Review Commission database. We included both open hysterectomies and those performed by minimally invasive surgery (MIS). Perioperative complications were defined using the Agency for Healthcare Research and Quality Patient Safety Indicators. Surgeon hysterectomy volume was analyzed by quartiles (0-5 = very low, 6-10 = low, 11-20 = medium, and 21+ cases = high volume). We utilized negative binomial regression and logistic regression to identify patient, surgeon, and hospital characteristics associated with MIS utilization and perioperative complications, respectively. A total of 5660 hospitalizations were identified during the study period. Most patients (61.5%) had an open hysterectomy; the remaining (38.6%) underwent a MIS procedure (25.1% robotic, 46.6% laparoscopic, and 28.3% vaginal). Most surgeons (68.2%) performed 10 or fewer hysterectomies during the 2+ year study period. Factors associated with a lower likelihood of undergoing MIS were older patient age (ref: 45-64 years; 20-44: OR = 1.17, 95% CI = 1.06-1.28), black race (ref: white; OR = 0.72, 95% CI = 0.65-0.80), Hispanic ethnicity (OR = 0.62, 95% CI = 0.48-0.79), smaller hospital size (ref: large; small: OR = 0.25, 95% CI = 0.15-0.44; medium: OR = 0.83, 95% CI = 0.75-0.91), and lower surgeon volume (ref: high; medium: OR = 0.87, 95% CI = 0.78-0.97). Complications occurred in 25.8% of open and 8.2% of MIS hysterectomies (P < 0.0001). While MIS hysterectomy was associated with fewer complications (OR = 0.22, 95% CI = 0.17-0.27), patient payer, including Medicare (ref: private; OR = 1.88, 95% CI = 1.34-2.64), Medicaid (OR = 1.70, 95% CI = 1.34-2.11) and self-pay status (OR = 2.49, 95% CI = 1.47-4.27), and low surgeon hysterectomy volume (ref: high; very low: OR = 1.91, 95% CI = 1.34-2.73; low: OR = 1.73, 95% CI = 1.22-2.47) were associated with perioperative complications. Use of minimally invasive hysterectomy for benign indications remains variable, with most patients undergoing open, more morbid procedures. Older and black patients, lower volume surgeons, and smaller hospitals were associated with open hysterectomy. Patient race and payer and lower surgeon volume were also associated with perioperative complications. Hysterectomies performed by high volume surgeons, and especially those with expertise in minimally invasive techniques, may represent an opportunity to reduce adverse events.

Patient, surgeon, and hospital disparities associated with benign hysterectomy approach and perioperative complications

Hysterectomy is among the most common major surgical procedures performed in women. Approximately 450,000 hysterectomy procedures are performed each year in the United States for benign indications. However, little is known regarding contemporary UShysterectomy trends for women with benign disease with respect tooperative technique and perioperative complications, and the association between these 2 factors with patient, surgeon, and hospital characteristics. We sought to describe contemporary hysterectomy trends and explore associations between patient, surgeon, and hospital characteristics with surgical approach and perioperative complications. Hysterectomies performed for benign indications by general gynecologists from July 2012 through September 2014 were analyzed in the all-payer Maryland Health Services Cost Review Commission database. We excluded hysterectomies performed by gynecologic oncologists, reproductive endocrinologists, and female pelvic medicine and reconstructive surgeons. We included both open hysterectomies and those performed by minimally invasive surgery, which included vaginal hysterectomies. Perioperative complications were defined using the Agency for Healthcare Research and Qualitypatient safety indicators. Surgeon hysterectomy volume during the 2-year study period was analyzed (0-5 cases annually= very low, 6-10= low, 11-20= medium, and ≥21= high). We utilized logistic regression and negative binomial regression to identify patient, surgeon, and hospital characteristics associated with minimally invasive surgery utilization and perioperative complications, respectively. A total of 5660 hospitalizations were identified during the study period. Most patients (61.5%) had an open hysterectomy; 38.5% underwent a minimally invasive surgery procedure (25.1% robotic, 46.6% laparoscopic, 28.3% vaginal). Most surgeons (68.2%) were very low- or low-volume surgeons. Factors associated with a lower likelihood of undergoing minimally invasive surgery included older patient age (reference 45-64 years; 20-44 years: adjusted odds ratio, 1.16; 95% confidence interval, 1.05-1.28), black race (reference white; adjusted odds ratio, 0.70; 95% confidence interval, 0.63-0.78), Hispanic ethnicity (adjusted odds ratio, 0.62; 95% confidence interval, 0.48-0.80), smaller hospital (reference large; small: adjusted odds ratio, 0.26; 95% confidence interval, 0.15-0.45; medium: adjusted odds ratio, 0.87; 95% confidence interval, 0.79-0.96), medium hospital hysterectomy volume (reference ≥200 hysterectomies; 100-200: adjusted odds ratio, 0.78; 95% confidence interval, 0.71-0.87), and medium vs high surgeon volume (reference high; medium: adjusted odds ratio, 0.87; 95% confidence interval, 0.78-0.97). Complications occurred in 25.8% of open and 8.2% of minimally invasive hysterectomies (P < .0001). Minimally invasive hysterectomy (adjusted odds ratio, 0.22; 95% confidence interval, 0.17-0.27) and large hysterectomy volume hospitals (reference ≥200 hysterectomies; 1-100: adjusted odds ratio, 2.26; 95% confidence interval, 1.60-3.20; 101-200: adjusted odds ratio, 1.63; 95% confidence interval, 1.23-2.16) were associated with fewer complications, while patient payer, including Medicare (reference private; adjusted oddsratio, 1.86; 95% confidence interval, 1.33-2.61), Medicaid (adjusted odds ratio, 1.63; 95% confidence interval, 1.30-2.04), and self-pay status (adjusted odds ratio, 2.41; 95% confidence interval, 1.40-4.12), and very-low and low surgeon hysterectomy volume (reference ≥21 cases; 1-5 cases: adjusted odds ratio, 1.73; 95% confidence interval, 1.22-2.47; 6-10 cases: adjusted odds ratio, 1.60; 95% confidence interval, 1.11-2.23) were associated with perioperative complications. Use of minimally invasive hysterectomy for benign indications remains variable, with most patients undergoing open, more morbid procedures. Older and black patients and smaller hospitals are associated with open hysterectomy. Patient race and payer status, hysterectomy approach, and surgeon volume were associated with perioperative complications. Hysterectomies performed for benign indications by high-volume surgeons or by minimally invasive techniques may represent an opportunity to reduce preventable harm.

Risk of Peripartum Hysterectomy and Center Hysterectomy and Delivery Volume.

To characterize where women at risk for and undergoing peripartum hysterectomy delivered in terms of obstetric volume and procedural experience. We used data from the Perspective database to retrospectively evaluate trends in peripartum hysterectomy and deliveries at high risk of peripartum hysterectomy based on placenta previa and prior cesarean delivery delivered from 2006 through 2014. Hospitals were categorized two separate ways for the analysis: 1) into five roughly equal quintiles based on annualized delivery volume and 2) by the mean number of hysterectomies performed annually over the study period. Four thousand eight hundred eleven hysterectomies occurred among 5,388,486 deliveries in 500 hospitals over the study period. The peripartum hysterectomy rate increased from 81.4 per 100,000 deliveries in 2006 to 98.4 in 2014. The prevalence rate of placenta previa in the setting of previous cesarean delivery also increased over the study period. Between 2006-2008 and 2012-2014, peripartum hysterectomy decreased in the lowest delivery volume quintile and increased in the highest delivery volume quintile (-14.9/100,000 deliveries, 95% confidence interval [CI] -25.6 to -4.2 and +35.4/100,000 deliveries, 95% CI 20.3-50.5, respectively). Similarly, hospitals performing high rates of hysterectomies saw the largest increase over the study period. With peripartum hysterectomy rates increasing in the population, hospitals with high delivery volumes and high rates of hysterectomies saw the largest increases in peripartum hysterectomy rates. These trends support that improved referral practices and uptake of evidence-based recommendations may be occurring.

Trends in Inpatient and Outpatient Hysterectomy and Oophorectomy Rates Among Commercially Insured Women in the United States, 2000-2014.

Trends in Inpatient and Outpatient Hysterectomy and Oophorectomy Rates Among Commercially Insured Women in the United States, 2000-2014.

Hysterectomy trends for benign indications over a 15-year period in an academic teaching center in Poland: a retrospective cohort study.

The aim of the study was to evaluate changes in the operative trends for various types of hysterectomy due to benign indications, between 2001 and 2015, at the 2nd Department of Gynecology, Medical University of Lublin, as compared to the National Health Service (NHS) registry in Poland. A retrospective cohort study was conducted. Data from the Internal Hospital Discharge Registry and Pathological Results Registry have been compared to the NHS database, which has been available nationwide since 2009. The study group included 5629 women who underwent hysterectomy due to benign indications. During the study period, the following number of procedures were performed: total abdominal hysterectomy - 344 (6.11%), total abdominal hysterectomy with bilateral salpingo-oophorectomy - 1760 (31.27%), total vaginal hysterectomy - 563 (10.00%), subtotal abdominal hysterectomy - 2536 (45.05%), and laparoscopically-assisted subtotal hysterectomy (LASH) - 426 (7.57%). The abdominal route, with the preference for subtotal abdominal hysterectomy, was the main approach to hysterectomy. Symptomatic fibroids were the most common indication for the procedure. Comparison of data collected over the last five years revealed a significant difference in the approach to hysterectomy in favor of subtotal abdominal hysterectomy (SAH) and LASH. Less invasive techniques of hysterectomy (LASH, SAH), which are the preferred choice at the 2nd Department of Gynecology (Lublin), are safe and effective options of treating benign conditions. We are of the opinion that these ap-proaches should be offered to patients instead of more radical techniques. Proper training of physicians may influence the decision-making process in favor of minimally invasive techniques.

Changes in Hysterectomy Trends and Patient Outcomes Following the Implementation of a Clinical Pathway [7

INTRODUCTION: The goal of this project is to describe the development and implementation of an evidence-based hysterectomy clinical pathway to reduce unnecessary variations in care and to promote improved patient outcomes at a reduced cost. This study characterized the longitudinal impact of hysterectomy pathway implementation on the number of total abdominal hysterectomy (TAH) procedures performed between fiscal years (FY) 2012 to 2014. METHODS: All noncancerous hysterectomy surgeries performed at University of Pittsburgh Medical Center (UPMC) hospitals from FY 2012 to FY 2014 were identified through various systems including Medipac and EpicCare. We analyzed the cases by surgical approach (TAH vs minimally invasive hysterectomy), age, and surgical indication. Changes over time were analyzed using Cochran-Armitage test for linear trends. RESULTS: A total number of 6,544 patients were included in this study (mean age 48.6 years, SD 11.69). The three most common indications for hysterectomy were: leiomyoma, menstruation disorders, and endometriosis. In FY 2012, 28.59% of hysterectomies performed due to noncancerous conditions were TAH, however, this number declined in FY 2013 to 23.35%, and further declined in FY 2014 to 17.86%. Overall, there was a significant reduction in the rate of TAH procedures, from 28.59% in FY 2012 to 17.86% in FY 2014 (P for trend<.001). In addition, there was a trend for reduction in wound infections, hospital readmissions, and complications. CONCLUSION/IMPLICATIONS: Implementation of a hysterectomy pathway has been associated with a decrease in the number of TAH hysterectomy procedures, reduced costs to the healthcare system, and improvements in patient outcomes.

Changes in Hysterectomy Trends After the Implementation of a Clinical Pathway

Changes in Hysterectomy Trends After the Implementation of a Clinical Pathway

Trends of hysterectomy in the rural tertiary level teaching hospitals in Northern India

Trends of hysterectomy in the rural tertiary level teaching hospitals in Northern India

Changes in Hysterectomy Trends After the Implementation of a Clinical Pathway.

To investigate the effect of hysterectomy pathway implementation on the proportion of total abdominal hysterectomy (TAH) procedures performed between fiscal years 2012 and 2014. We conducted a retrospective medical record review. All hysterectomy surgeries performed for benign indications at University of Pittsburgh Medical Center hospitals from fiscal year 2012 to fiscal year 2014 were identified through various systems including Medipac and EpicCare. We analyzed the cases by surgical approach (TAH compared with minimally invasive hysterectomy), age, and indication of surgery. Changes over time were analyzed using Cochran-Armitage test for linear trends. A total number of 6,544 patients were included in this study. The mean age of the participants was 48.6 years (standard deviation 11.69). In fiscal year 2012, of 1,934 hysterectomies performed as a result of noncancerous conditions, 538 were TAH procedures (27.8%). However, this number declined in fiscal year 2013 to 22% (485 TAH procedures of 2,186 hysterectomies) and further declined in fiscal year 2014 to 17% (413 TAH surgeries of 2,424 hysterectomies). Overall, there was a significant reduction in the proportion of TAH procedures, from 27.8% in fiscal year 2012 to 17% in fiscal year 2014 (P for trend <.001). After adjusting for surgery indication, the decreasing trend of TAH procedures still persisted (P for trend <.001). Implementation of a hysterectomy pathway has been associated with a decrease in the proportion of TAH hysterectomy procedures.

Hysterectomy Trends Before and After the FDA Morcellator Warning: Have We Changed Our Practice and Perioperative Outcomes?

Hysterectomy Trends Before and After the FDA Morcellator Warning: Have We Changed Our Practice and Perioperative Outcomes?