Department of Gynaecology, Poole Hospital, Dorset, UK.
Barts and The London School of Medicine and Dentistry, Blizard Institute, London, UK.
BJOG. 2019 May;126(6):795-802. doi: 10.1111/1471-0528.15539. Epub 2018 Dec 30.
To assess variation in the route of hysterectomy over 7 years and to assess regional variation in practice.
Retrospective cohort study.
English NHS Hospitals 2011-2017.
230 876 patients having a hysterectomy for six diagnostic categories (endometrial cancer, endometriosis and pain, menstrual disorders, fibroids, benign adnexal masses, and 'other') identified from Hospital Episode Statistics.
The proportion of hysterectomies carried out by each route was calculated for each year overall and for each primary diagnosis by year. Comparisons between 2011 and 2017 were via chi-square test. Rank correlation coefficients were calculated to assess trends over the study period. Analysis of regional variation in practice was restricted to 2017. A multivariable logistic regression was performed to obtain crude and adjusted odds of having a minimal access hysterectomy.
The proportion of abdominal, vaginal, laparoscopic, and failed laparoscopic procedures for each primary diagnosis by study year. Odds of a minimal access hysterectomy in 2017.
The proportion of hysterectomies performed laparoscopically increased from 20.2% in 2011 to 47.2% in 2017, as did the proportion of failed laparoscopic procedures; 1.7% in 2011 to 2.8% in 2017. The proportion of abdominal hysterectomies decreased from 70.4% in 2011 to 46.5% in 2017. There was a smaller decrease in vaginal procedures from 7.8% in 2011 to 3.5% in 2017. Regional variation in the route of hysterectomy was demonstrated in 2017, which persisted when adjusted for confounding factors.
The proportion of laparoscopic procedures has increased, and it was the commonest route of hysterectomy for this cohort in 2017. There were significant regional differences in route of hysterectomy in 2017.
Increasing laparoscopic hysterectomy and decreasing abdominal hysterectomy rates from 2011 to 2017 with regional variation in practice.
评估 7 年来子宫切除术途径的变化，并评估实践中的区域差异。
回顾性队列研究。
2011-2017 年英国国民保健制度医院。
从医院病例统计中确定的 6 种诊断类别（子宫内膜癌、子宫内膜异位症和疼痛、月经失调、肌瘤、良性附件肿块和“其他”）的 230876 名接受子宫切除术的患者。
计算了每年和每年主要诊断的每种手术途径的子宫切除术比例。2011 年和 2017 年之间的比较通过卡方检验进行。计算秩相关系数以评估研究期间的趋势。实践中的区域差异分析仅限于 2017 年。进行多变量逻辑回归以获得微创子宫切除术的原始和调整优势比。
按研究年份列出的每个主要诊断的腹部、阴道、腹腔镜和失败的腹腔镜手术的比例。2017 年微创子宫切除术的可能性。
腹腔镜子宫切除术的比例从 2011 年的 20.2%增加到 2017 年的 47.2%，失败的腹腔镜手术比例也从 2011 年的 1.7%增加到 2017 年的 2.8%。2011 年的 70.4%下降到 2017 年的 46.5%。阴道手术的比例从 2011 年的 7.8%下降到 2017 年的 3.5%，下降幅度较小。2017 年显示出子宫切除术途径的区域差异，在调整混杂因素后仍然存在。
腹腔镜手术的比例有所增加，2017 年该队列中最常见的子宫切除术途径。2017 年手术途径存在明显的区域差异。
从 2011 年到 2017 年，腹腔镜子宫切除术的比例增加，腹部子宫切除术的比例下降，且实践中的区域差异显著。
Zotero 插件