Nationwide Trends in the Performance of Inpatient Hysterectomy in the United States
ABSTRACT To examine the use of inpatient hysterectomy and explore changes in the use of various routes of hysterectomy and patterns of referral.
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.
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).
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%.
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ABSTRACT: A hybrid technique of robot-assisted, laparoscopic hysterectomy using the ENSEAL® Tissue Sealing Device is described in a retrospective, consecutive, observational case series. Over a 45 month period, 590 robot-assisted total laparoscopic hysterectomies +/- oophorectomy for benign and malignant indications were performed by a single surgeon with a bedside assistant at a tertiary healthcare center. Patient demographics, indications for surgery, comorbidities, primary and secondary surgical procedures, total operative and surgical time, estimated blood loss (EBL), length of stay (LOS), complications, transfusions and subsequent readmissions were analyzed. The overall complication rate was 5.9% with 35 patients experiencing 69 complications. Mean (SD) surgery time, operating room (OR) time, EBL, and LOS for the entire cohort were 75.5 (39.42) minutes, 123.8 (41.15) minutes, 83.1 (71.29) millilitres, and 1.2 (0.93) days, respectively. Mean surgery time in the first year (2009) was 91.6 minutes, which declined significantly each year by 18.0, 19.0, and 24.3 minutes, respectively. EBL and LOS did not vary significantly across the entire series. Using the cumulative sum method, an optimization curve for surgery time was evaluated, with three distinct optimization phases observed. In summary, the use of an advanced laparoscopic tissue-sealing device by a bedside surgical assistant provided an improved operative efficiency and reliable vessel sealing during robotic hysterectomy.01/2014; 6(3):133-42.
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ABSTRACT: Minimally invasive technology, especially robotics, is gaining widespread acceptance and is becoming the standard approach for the treatment of both benign and malignant gynecologic conditions in centers across the country. However, there are challenges on a systems-based level to the implementation of a robotic program. Prominent among the concerns is the length of the learning curve, team-building, quality of life, and financial and various organizational challenges. The purpose of this review article is to address those challenges as milestones on the progress to a successful robotics program and explore possible solutions.Obstetrics and Gynecology 01/2014; 123(1):13-20. DOI:10.1097/AOG.0000000000000055 · 4.37 Impact Factor
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ABSTRACT: Introduction hysterectomy is the most commonly performed gynecological surgical procedure. The preservation of the cervix is still under discussion, especially the possible consequences associated with their removal. One of the most questioned, and yet no consensus is interference in sexuality. Objective the aim of the study was to review the literature to assess whether there is difference with regard to sexuality, in women undergoing total or subtotal hysterectomy. Method an electronic search was performed with Pubmed database. We used the terms total hysterectomy and subtotal hysterectomy and our search retrieved 250 articles. Among these, 34 compared the type of hysterectomy and 10 addressed the issue of sexuality associated torelevant variants of interest to the article. Results among the original articles, only 10 addressed the issue of sexuality, along with other variables or as a central theme of the article. Only one study reported a difference in sexuality between the two types of surgery, with a significant positive change in frequency of orgasm and sexual pleasure in women undergoing subtotal hysterectomy. In six studies, the authors found no difference between the two types of surgery. Conclusion only one of the studies presented results from impair sexuality, but were similar in the two types of surgery. Although there is still no consensus on the effects of hysterectomy on sexuality, there seems to be no difference between the two types of procedure. Thus, the decision must be taken individually, respecting the indications, the clinical conditions of each patient and surgeon experience.01/2014; 28(3). DOI:10.1016/j.recli.2014.05.001