Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, Bronx, New York; the Accreditation Council for Graduate Medical Education, Chicago, Illinois; and the Department of Obstetrics and Gynecology, Virginia Tech Carilion School of Medicine, Roanoke, Virginia.
Obstet Gynecol. 2020 Feb;135(2):268-273. doi: 10.1097/AOG.0000000000003637.
To characterize trends in self-reported numbers and routes of hysterectomy for obstetrics and gynecology residents using the Accreditation Council for Graduate Medical Education (ACGME) case log database.
Hysterectomy case log data for obstetrics and gynecology residents completing training between 2002-2003 and 2017-2018 were abstracted from the ACGME database. Total numbers of hysterectomies and modes of approach (abdominal, laparoscopic, and vaginal) were compared using bivariate statistics, and trends over time were analyzed using simple linear regression.
Hysterectomy data were collected from 18,982 obstetrics and gynecology residents in a median of 243 (interquartile range 241-246) ACGME-accredited programs. The number of graduating residents increased significantly over time (12.1/year, P<.001), whereas the number of residency programs decreased significantly (0.52 fewer programs per year, P<.001) over the 16-year period. For cases logged as "surgeon," the median number of abdominal hysterectomies decreased by 56.5% from 85 (interquartile range 69-102) to 37 (interquartile range 34-43) (P<.001). The median number of vaginal hysterectomies decreased by 35.5% from 31 (interquartile range 24-39) to 20 (interquartile range 17-25) (P=.002). The median total number of hysterectomies per resident decreased by 6.3% from 112 (interquartile range 97-132) to 105 (interquartile range 92-121) (P=.036). In contrast, the median number of laparoscopic hysterectomies increased by 115% from 20 (interquartile range 13-28) in 2008-2009 to 43 (interquartile range 32-56) in 2017-2018, despite the decrease in overall number of hysterectomies (P<.001). These trends were statistically significant.
The total number of hysterectomies performed by obstetrics and gynecology residents in the United States is decreasing, and the routes are changing with decreases in abdominal and vaginal approaches, and an increase in use of laparoscopic hysterectomy.
利用毕业后医学教育认证委员会（ACGME）的住院医师病历数据库，描述妇产科住院医师报告的子宫切除术数量和手术路径的变化趋势。
从 ACGME 数据库中提取 2002-2003 年至 2017-2018 年期间完成培训的妇产科住院医师的子宫切除术病历数据。使用双变量统计比较子宫切除术的总数和手术入路（腹部、腹腔镜和阴道），并使用简单线性回归分析随时间的变化趋势。
在 18982 名妇产科住院医师中，收集了 243（四分位距 241-246）个经 ACGME 认证的项目的数据。毕业住院医师的数量随着时间的推移显著增加（每年增加 12.1 人，P<.001），而住院医师项目的数量在 16 年内显著减少（每年减少 0.52 个项目，P<.001）。对于记录为“外科医生”的病例，腹部子宫切除术的中位数从 85（四分位距 69-102）下降到 37（四分位距 34-43）（P<.001），下降了 56.5%。阴道子宫切除术的中位数从 31（四分位距 24-39）下降到 20（四分位距 17-25）（P=.002），下降了 35.5%。每位住院医师的子宫切除术总数中位数从 112（四分位距 97-132）下降到 105（四分位距 92-121）（P=.036），下降了 6.3%。相比之下，尽管总的子宫切除术数量减少了，但腹腔镜子宫切除术的中位数从 2008-2009 年的 20（四分位距 13-28）增加到 2017-2018 年的 43（四分位距 32-56），增加了 115%（P<.001）。这些趋势具有统计学意义。
美国妇产科住院医师进行的子宫切除术总数正在减少，手术路径也在发生变化，腹部和阴道入路减少，腹腔镜子宫切除术增加。
Zotero 插件