Mikhail Emad, Salemi Jason L, Mogos Mulubrhan F, Hart Stuart, Salihu Hamisu M, Imudia Anthony N
Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL.
Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL; Department of Family and Community Medicine, Baylor College of Medicine, Waco, TX.
Am J Obstet Gynecol. 2015 Nov;213(5):713.e1-13. doi: 10.1016/j.ajog.2015.04.031. Epub 2015 Apr 30.
We sought to investigate the most recent national trends of bilateral salpingectomy (BS) and bilateral salpingo-oophorectomy (BSO) at the time of hysterectomy performed for benign indications.
We conducted a national cross-sectional analysis of all inpatient discharges for women aged ≥18 years who underwent a hysterectomy for benign indications from 1998 through 2011 using the largest publicly available all-payer inpatient database in the United States. We scanned International Classification of Diseases, Ninth Revision codes for an indication of specific bilateral adnexal surgeries, including BSO and BS. Joinpoint regression was used to characterize and estimate 14-year national trends in performing BSO and BS at the time of hysterectomy for benign indications, overall and in population subgroups.
During the study period, there were approximately 428,523 inpatient hysterectomy procedures performed annually for benign indications. Of these, >53% had no adnexal surgery performed during the same hospitalization, whereas 43.7% and 1.3% of those discharges had BSO and BS procedures, respectively. The rate of BSO was directly correlated with increasing age for patients <65 years. Conversely, we observed an inverse relationship between BS and patient age, with the BS rate among women aged <25 years twice that of women aged ≥45 years. From 1998 through 2001, there was a 2.2% increase in the rate of BSO per year (95% confidence interval, 0.4-4.0); however, this was followed by a consistent 3.6% (95% confidence interval, -4.0 to -3.3) annual decline in the BSO rate, from 49.7% in 2001 to 33.4% in 2011. National rates of BS among women undergoing hysterectomy for benign indications increased significantly throughout the study period, with an estimated 8% annual increase from 1998 through 2008, followed by a sharp 24% increase annually during the last 4 years of the study period. The BS rate nearly quadrupled in 14 years.
The type of adnexal surgery performed concomitantly with hysterectomy for benign indications has undergone a significant shift since 2001. Significantly more BS and less BSO procedures are being performed among gynecologic surgeons in the United States.
我们试图调查因良性指征行子宫切除术时双侧输卵管切除术（BS）和双侧输卵管卵巢切除术（BSO）的最新全国趋势。
我们使用美国最大的公开可用的全付费者住院数据库，对1998年至2011年期间因良性指征接受子宫切除术的≥18岁女性的所有住院出院病例进行了全国横断面分析。我们扫描了国际疾病分类第九版代码，以查找特定双侧附件手术（包括BSO和BS）的指征。采用连接点回归来描述和估计因良性指征行子宫切除术时进行BSO和BS的14年全国趋势，包括总体趋势和人群亚组趋势。
在研究期间，每年约有428,523例因良性指征进行的住院子宫切除手术。其中，>53%的患者在同一住院期间未进行附件手术，而这些出院患者中分别有43.7%和1.3%进行了BSO和BS手术。对于年龄<65岁的患者，BSO的发生率与年龄增长直接相关。相反，我们观察到BS与患者年龄呈负相关，<25岁女性的BS发生率是≥45岁女性的两倍。从1998年到2001年，BSO的发生率每年增加2.2%（95%置信区间，0.4 - 4.0）；然而，随后BSO的发生率持续每年下降3.6%（95%置信区间，-4.0至-3.3），从2001年的49.7%降至2011年的33.4%。在整个研究期间，因良性指征行子宫切除术的女性中BS的全国发生率显著增加，从1998年到2008年估计每年增加8%，在研究期的最后4年每年急剧增加24%。在14年中，BS的发生率几乎翻了两番。
自2001年以来，因良性指征行子宫切除术时同时进行的附件手术类型发生了显著变化。在美国妇科外科医生中，进行BS的手术明显增多，而进行BSO的手术减少。
