Nationwide Trends in the Performance of Inpatient Hysterectomy in the United States

Abstract

OBJECTIVE To examine the use of inpatient hysterectomy and explore changes in the use of various routes of hysterectomy and patterns of referral. METHODS The Nationwide Inpatient Sample was used to identify all women aged 18 years or older who underwent inpatient hysterectomy between 1998 and 2010. Weighted estimates of national trends were calculated and the number of procedures performed estimated. Trends in hospital volume and across hospital characteristics were examined. RESULTS After weighting, we identified a total 7,438,452 women who underwent inpatient hysterectomy between 1998 and 2010. The number of hysterectomies performed annually rose from 543,812 in 1998 to a peak of 681,234 in 2002; it then declined consistently annually and reached 433,621 cases in 2010. Overall, 247,973 (36.4%) fewer hysterectomies were performed in 2010 compared with 2002. From 2002 to 2010 the number of hysterectomies performed for each of the following indications declined: leiomyoma (−47.6%), abnormal bleeding (−28.9%), benign ovarian mass (−63.1%), endometriosis (−65.3%), and pelvic organ prolapse (−39.4%). The median hospital case volume decreased from 83 procedures per year in 2002 to 50 cases per year in 2010 (P<.001). CONCLUSION The number of inpatient hysterectomies performed in the United States has declined substantially over the past decade. The median number of hysterectomies per hospital has declined likewise by more than 40%. LEVEL OF EVIDENCE III

Introduction of Laparoscopic Hysterectomy Approach: Decreasing the Abdominal Hysterectomy Approach or Replacing Vaginal Hysterectomy

“…1 Despite several minimally invasive techniques now available, including Total Vaginal Hysterectomy (TVH) and Laparoscopic Hysterectomy (LH) approaches, the vast majority are still performed with a laparotomy or via the Abdominal Hysterectomy (AH). [1][2][3] It has been reported that over two thirds of hysterectomies continue to be performed in the United States as open abdominal procedures, with the lowest rates in the Southern region.…”

“…1 Despite several minimally invasive techniques now available, including Total Vaginal Hysterectomy (TVH) and Laparoscopic Hysterectomy (LH) approaches, the vast majority are still performed with a laparotomy or via the Abdominal Hysterectomy (AH). [1][2][3] It has been reported that over two thirds of hysterectomies continue to be performed in the United States as open abdominal procedures, with the lowest rates in the Southern region. [1][2][3][4] It has been well established that minimally invasive techniques, both laparoscopic and vaginal hysterectomy, have distinct advantages over abdominal approaches, including decreased length of hospitalization, reduced postoperative infections, shorter recovery times, and decreased blood loss.…”

“…[1][2][3] It has been reported that over two thirds of hysterectomies continue to be performed in the United States as open abdominal procedures, with the lowest rates in the Southern region. [1][2][3][4] It has been well established that minimally invasive techniques, both laparoscopic and vaginal hysterectomy, have distinct advantages over abdominal approaches, including decreased length of hospitalization, reduced postoperative infections, shorter recovery times, and decreased blood loss. [1][2][3][4][5][6][7][8][9][10][11] Historically, TVH has been the route of choice among gynecologists; training for this surgical procedure has been well integrated into Obstetrics and Gynecology residency programs over the past 30 years.…”

“…[1][2][3][4] It has been well established that minimally invasive techniques, both laparoscopic and vaginal hysterectomy, have distinct advantages over abdominal approaches, including decreased length of hospitalization, reduced postoperative infections, shorter recovery times, and decreased blood loss. [1][2][3][4][5][6][7][8][9][10][11] Historically, TVH has been the route of choice among gynecologists; training for this surgical procedure has been well integrated into Obstetrics and Gynecology residency programs over the past 30 years. 5,8 The introduction of laparoscopic techniques, including Laparoscopic Assisted Vaginal Hysterectomy (LAVH), Total Laparoscopic Hysterectomy (TLH), Laparoscopic Supracervical Hysterectomy (LSH), and robotic-assisted hysterectomy (TLH/LSH), had promise to continue decreasing the numbers of AH performed in the United States; these approaches have become integrated into residency training since the early to mid-2000's.…”

Moving from vaginal hysterectomy to “no-incision” hysterectomy: how terminology has an impact

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It is estimated that one in three women undergo hysterectomy in the USA, with the majority of these procedures performed via open abdominal surgery [1]. It is well known that morbidity related to hysterectomy can be reduced by using less invasive surgical techniques, such as vaginal and laparoscopic approaches.

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