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. 2019 Apr;133(4):643-649.
doi: 10.1097/AOG.0000000000003181.

Hysterectomy Practice Patterns in the Postmorcellation Era

Elisa M Jorgensen  1 , Anna M Modest, Hye-Chun Hur, Michele R Hacker, Christopher S Awtrey
Affiliations

Hysterectomy Practice Patterns in the Postmorcellation Era

Elisa M Jorgensen et al. Obstet Gynecol. 2019 Apr.

Abstract

Objective: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

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Figures

Figure 1:
Figure 1:
Proportion of hysterectomies performed by mode of incision, per quarter. The proportion of abdominal hysterectomies was unchanged prior to the December 18, 2013 Wall Street Journal (WSJ) article (P=.14). Between the WSJ article and the April 17, 2014 U.S. Food and Drug Administration (FDA) safety communication, abdominal hysterectomy increased 1.1% per quarter (P<.001), then remained stable until March 2015 (P=.65). After March 2015, the proportion of abdominal hysterectomies decreased by 0.8% per quarter through the end of 2016 (P<.001). Error bars represent the 95% CI of the proportion of hysterectomies. Dotted lines indicate the WSJ article and the FDA safety communication.
Figure 2:
Figure 2:
Supracervical hysterectomy practice patterns. A. Proportion of total and supracervical hysterectomies, per quarter. Prior to the December 18, 2013 Wall Street Journal (WSJ) article, the proportion of supracervical hysterectomies decreased by 0.2% per quarter (P=.005). Between the WSJ article and the April 17, 2014 U.S. Food and Drug Administration (FDA) safety communication, supracervical hysterectomies decreased by 1.0% per quarter (P<.001), followed by a 0.7% decrease per quarter (P=.01) until March 2015, when the proportion stabilized (P=.40). B. Proportion of supracervical hysterectomies performed by mode of incision, per quarter. Prior to the WSJ article, there was no change to the proportion of abdominal supracervical hysterectomies (P=.43). Between the WSJ article and the FDA safety communication, there was a 11.7% per quarter increase in the proportion of abdominal supracervical hysterectomies, (P<.001), which then remained stable through the end of 2016 (P=.06). Error bars represent the 95% CI of the proportion of supracervical hysterectomies. Error bars represent the 95% CI of the proportion of hysterectomies. Dotted lines indicate the WSJ article and the FDA safety communication.
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References

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