Hysterectomy surgery trends: a more accurate depiction of the last decade?

Abstract

Objective: The objective of the study was to describe trends in hysterectomy route at a large tertiary center.

Study design: We reviewed all hysterectomies performed at Magee-Womens Hospital from 2000 to 2010. This database was chosen over larger national surveys because it has been tracking laparoscopic procedures since 2000, well before laparoscopic hysterectomy International Classification of Diseases, ninth revision (ICD-9) procedure codes were developed.

Results: There were 13,973 patients included who underwent hysterectomy at Magee-Womens Hospital. In 2000, 3.3% were laparoscopic (LH), 74.5% abdominal (AH), and 22.2% vaginal hysterectomy (VH). By 2010, LH represented 43.5%, AH 36.3%, VH 17.2%, and 3.0% laparoscopic converted to open (LH→AH). Hysterectomies performed for gynecological malignancy represented 24.4% of cases. The average length of stay for benign LH and VH, 1.0 ± 1.0 and 1.6 ± 1.0 days respectively, was significantly shorter than the average 3.1 ± 2.3 day stay associated with AH (P < .001). The average patient age was 46.9 ± 10.9 years for LH, 51.5 ± 12.1 years for AH, and 51.7 ± 14.1 years for VH, and over the study period there was a significant trend of increasing patient age (b1 = 0.517, 0.583, and 0.513, respectively [P < .001 for all]).

Conclusion: The percentage of LH increased over the last decade and by 2010 had surpassed AH. The 43.4% LH rate in 2010 is much higher than previously reported in national surveys. This likely is due to an increase in the number of laparoscopic procedures being performed over the last few years as well as the ability of our study to capture LH prior to development of appropriate ICD-9 procedure codes. Our unique ability to determine hysterectomy route, which predates appropriate coding, may provide a more accurate characterization of hysterectomy trends.

Figure 1. Study Flowchart

Hysterectomy group assignment by MWH and ICD-9 codes MWH code, Magee Womens Hospital institutional code ICD-9; International Classification of Diseases, 9th Revision

Figure 2. Hysterectomies for benign indications

Hysterectomies performed for benign indications 2000–2010, stratified by route

Figure 3. Hysterectomies for gynecologic malignancy

Hysterectomies performed for gynecologic malignancy 2000–2010, stratified by route

Figure 4. Mean age of women undergoing castration at time of hysterectomy

Mean age of women undergoing hysterectomy with concominant bilateral oophorectomy or removal of remaining oophorectomy 2000–2010. P < 0.001.