From the Section of Urogynecology, Department of Obstetrics and Gynecology, Providence Saint John's Health Center, Santa Monica, CA.
Research and Consulting Ltd, London, United Kingdom.
Female Pelvic Med Reconstr Surg. 2021 Jun 1;27(6):382-387. doi: 10.1097/SPV.0000000000000879.
Although guidelines recommend hysterectomy be performed vaginally whenever possible, recent trainees have decreased exposure to vaginal hysterectomy given the availability of laparoscopic hysterectomy, nonsurgical management, and falling volume nationwide. We sought to estimate hysterectomy volume in the 5 years after residency. Our secondary objective was to compare vaginal hysterectomy utilization between recent graduates and senior surgeons.
Retrospective, statewide data from 2005 to 2014 was obtained from the Massachusetts Center for Health Information Analysis. All hysterectomies performed in Massachusetts, regardless of payer type, were included. Surgeon identifiers were cross-referenced to another data set with provider demographics. Hysterectomies performed in the first 5 years after graduation were compared with a group 21 to 25 years after residency.
Data from inpatient and outpatient databases revealed 87,846 hysterectomies performed by 1967 physicians, including 3146 simple hysterectomies by 192 recent graduates. Recent graduates chose abdominal hysterectomy (44.2%) most commonly, followed by laparoscopic (29.4%), vaginal (16.1%), and laparoscopically assisted vaginal (10.4%). Recent graduates performed a median of 3 to 4 hysterectomies in each of the first 5 years with no increase over time (P = 1). The median number of vaginal or laparoscopic hysterectomies was 0 in these 5 years (interquartile ranges, 0-1 and 0-2, respectively). Members of the senior cohort performed a median of 8 to 9 hysterectomies annually, completing them vaginally more often (24.7% vs 16.1%, P < 0.01). When controlling for patient age and hysterectomy indication, this effect dissipated.
Recent graduates perform 3 to 4 (interquartile range, 1-7) hysterectomies annually, predominantly by laparotomy. Although senior surgeons perform vaginal hysterectomy more often, this is explained by patient characteristics.
尽管指南建议只要有可能，就应通过阴道进行子宫切除术，但由于腹腔镜子宫切除术、非手术治疗以及全国范围内手术量的减少，最近的受训者接触阴道子宫切除术的机会减少了。我们试图估计住院医师培训后 5 年内的子宫切除术量。我们的次要目标是比较最近毕业的医生和资深外科医生之间阴道子宫切除术的使用情况。
从马萨诸塞州健康信息分析中心获得了 2005 年至 2014 年的回顾性全州数据。包括马萨诸塞州所有类型支付者的所有子宫切除术。将外科医生标识符与另一个包含提供者人口统计信息的数据集中进行交叉引用。将毕业后 5 年内进行的子宫切除术与毕业后 21 至 25 年内进行的一组子宫切除术进行比较。
来自住院和门诊数据库的数据显示，1967 名医生共进行了 87846 例子宫切除术，其中 192 名最近毕业的医生进行了 3146 例单纯子宫切除术。最近毕业的医生最常选择剖腹子宫切除术（44.2%），其次是腹腔镜（29.4%）、阴道（16.1%）和腹腔镜辅助阴道（10.4%）。最近毕业的医生在头 5 年内每年平均进行 3 到 4 例子宫切除术，且随着时间的推移没有增加（P = 1）。在这 5 年内，这些医生的阴道或腹腔镜子宫切除术中位数均为 0（四分位间距，分别为 0-1 和 0-2）。资深医生组每年平均进行 8 至 9 例子宫切除术，且更常进行阴道子宫切除术（24.7%比 16.1%，P < 0.01）。在控制患者年龄和子宫切除术指征后，这种影响消失了。
最近毕业的医生每年进行 3 到 4 例（四分位间距，1-7）子宫切除术，主要通过剖腹术进行。尽管资深外科医生更常进行阴道子宫切除术，但这是由患者特征决定的。
