Cohen Sarah L, Ajao Mobolaji O, Clark Nisse V, Vitonis Allison F, Einarsson Jon I
Division of Minimally Invasive Gynecologic Surgery and the Department of Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Boston, Massachusetts.
Obstet Gynecol. 2017 Jul;130(1):130-137. doi: 10.1097/AOG.0000000000002103.
To estimate the number of outpatient hysterectomies being performed annually in the United States in an effort to offer more correct estimates of hysterectomy use in light of reported decreasing inpatient case volume.
This is a cross-sectional analysis of State Ambulatory Surgery and Services Databases from 16 states with complete information for year 2011. Adult women undergoing hysterectomy were included. Procedure volume, route, and associated patient and surgical characteristics were calculated.
There were 64,612 ambulatory hysterectomies reported; 81.5% of surgeries were performed laparoscopically and 16% vaginally. If these numbers are extrapolated to national estimates, this represents 100,000-200,000 outpatient hysterectomies per year. The strongest driver of the laparoscopic, compared with vaginal, route of hysterectomy in this data set was presence of cancer (odds ratio 4.01 [3.19-5.05], P<.001). In addition to indication for surgery, patient characteristics such as age, race, income, location, and primary payer were associated with mode of hysterectomy. The laparoscopic surgeries were associated with shorter length of stay (mean stay 0.65 days, [99% confidence interval 0.65-0.66] compared with 0.79 days [0.78-0.81], adjusted incidence rate ratio 0.89 [0.86-0.92], P<.001) and higher mean charges ($24,227 [$24,053-24,402] versus $14,068 [$13,811-14,330], P<.001) compared with vaginal surgeries.
The perceived decline that has been reported in national hysterectomy volume may represent lack of reporting of surgeries performed in ambulatory settings. This information has considerable implications for business, public health interventions, and insurance carriers among other key stakeholders in women's health care delivery.
鉴于报告的住院病例数量下降，估计美国每年门诊子宫切除术的实施数量，以便更准确地估计子宫切除术的使用情况。
这是一项对16个州的州门诊手术和服务数据库进行的横断面分析，这些数据库包含2011年的完整信息。纳入接受子宫切除术的成年女性。计算手术量、手术途径以及相关的患者和手术特征。
报告了64,612例门诊子宫切除术；81.5%的手术通过腹腔镜进行，16%通过阴道进行。如果将这些数字外推至全国估计数，则每年代表10万至20万例门诊子宫切除术。在该数据集中，与阴道途径相比，腹腔镜子宫切除术的最强驱动因素是癌症的存在（优势比4.01[3.19 - 5.05]，P <.001）。除了手术指征外，患者特征如年龄、种族、收入、地理位置和主要支付方与子宫切除术的方式相关。与阴道手术相比，腹腔镜手术的住院时间更短（平均住院时间0.65天，[99%置信区间0.65 - 0.66]，而阴道手术为0.79天[0.78 - 0.81]，调整后的发病率比为0.89[0.86 - 0.92]，P <.001），平均费用更高（24,227美元[24,053 - 24,402]对14,068美元[13,811 - 14,330]，P <.001）。
全国子宫切除术数量报告中所感知到的下降可能代表门诊手术未被报告。该信息对商业、公共卫生干预措施以及保险机构等女性医疗保健提供中的其他关键利益相关者具有重要意义。
