Department of Obstetrics and Gynecology (Drs. Nguyen, Salyer, and Zaritsky), Kaiser Permanente Northern California, Oakland, California.
Division of Research (Dr. Merchant), Kaiser Permanente Northern California, Oakland, California.
J Minim Invasive Gynecol. 2019 Jul-Aug;26(5):847-855. doi: 10.1016/j.jmig.2018.08.013. Epub 2018 Aug 28.
To investigate rates of utilization of alternative treatments before hysterectomy for benign gynecologic indications within a large integrated health care system.
Retrospective cohort study of patients who underwent hysterectomies for benign gynecologic conditions between 2012 and 2014 (Canadian Task Force classification II-2).
Kaiser Permanente Northern California, a community-based integrated health system.
Women who underwent hysterectomy for a benign gynecologic condition between 2012 and 2014.
From an eligible cohort of 6892 patients who underwent hysterectomy, a stratified random sample of 1050 patients were selected for chart review. Stratification was based on the proportion of indications for hysterectomy.
The primary outcome was the use of alternative treatments before hysterectomy. Alternative treatments included oral hormone treatment, leuprolide, medroxyprogesterone intramuscular injections, a levonorgestrel intrauterine device, hormonal subdermal implants, endometrial ablation, uterine artery embolization, hysteroscopy, and myomectomy. Of the 1050 charts reviewed, 979 (93.2%) met the criteria for inclusion in this study. The predominant indication for hysterectomy was symptomatic myomas (54.4%), followed by abnormal uterine bleeding (29.0%), endometriosis (5.8%), pelvic pain (3.1%), dysmenorrhea (3.4%), and other (4.3%). The major routes of hysterectomy were laparoscopy (68.7%) and vaginal hysterectomy (13.4%). Before hysterectomy, 81.2% of patients tried at least 1 type of alternative treatment (33.8% with 1 treatment and 47.4% with at least 2 treatments), and 99.3% of patients were counseled regarding alternative treatments. Compared with younger women age <40 years, women age 45 to 49 years were less likely to use alternative treatments before hysterectomy (adjusted odds ratio, 0.41; 95% confidence interval, 0.21-0.76). There were no variations in treatment rates by socioeconomic status or between major racial and ethnic groups. The final pathological analysis identified myomas as the most common pathology (n = 637; 65.1%); 96 patients (9.8%) had normal uterine pathology.
More than 80% of patients received alternative treatments before undergoing hysterectomy for a benign gynecologic condition. Additional investigation is warranted to assess alternative treatment use as it relates to preventing unnecessary hysterectomies.
在一个大型综合医疗保健系统中，调查良性妇科指征行子宫切除术之前替代治疗的使用率。
对 2012 年至 2014 年间因良性妇科疾病接受子宫切除术的患者进行回顾性队列研究（加拿大任务组分类 II-2）。
凯撒永久北加利福尼亚，一个基于社区的综合医疗系统。
因良性妇科疾病接受子宫切除术的女性。
从接受子宫切除术的 6892 名合格患者中，选择了 1050 名患者进行图表审查。分层基于子宫切除术指征的比例。
主要结局是子宫切除术前替代治疗的使用。替代治疗包括口服激素治疗、亮丙瑞林、醋酸甲羟孕酮肌内注射、左炔诺孕酮宫内节育器、激素皮下埋植、子宫内膜消融、子宫动脉栓塞、宫腔镜检查和子宫肌瘤切除术。在审查的 1050 份图表中，979 份（93.2%）符合纳入本研究的标准。子宫切除术的主要指征是症状性肌瘤（54.4%），其次是异常子宫出血（29.0%）、子宫内膜异位症（5.8%）、盆腔疼痛（3.1%）、痛经（3.4%）和其他（4.3%）。子宫切除术的主要途径是腹腔镜（68.7%）和阴道子宫切除术（13.4%）。在子宫切除术之前，81.2%的患者至少尝试过 1 种替代治疗方法（33.8%使用 1 种治疗方法，47.4%使用至少 2 种治疗方法），99.3%的患者接受了替代治疗的咨询。与年龄<40 岁的年轻女性相比，45 至 49 岁的女性在子宫切除术之前使用替代治疗的可能性较小（调整后的优势比，0.41；95%置信区间，0.21-0.76）。社会经济地位或主要种族和族裔群体之间的治疗率没有差异。最终的病理分析确定肌瘤是最常见的病理（n=637；65.1%）；96 名患者（9.8%）子宫病理学正常。
超过 80%的患者在因良性妇科疾病接受子宫切除术之前接受了替代治疗。需要进一步研究以评估替代治疗的使用与预防不必要的子宫切除术的关系。
