Lerner Veronica, Chen Ling, Xu Xiao, Myers Evan, Wright Jason D
Department of Obstetrics & Gynecology, Lenox Hill Hospital, the Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, the Herbert Irving Comprehensive Cancer Center, and NewYork-Presbyterian Hospital, New York, Northwell, New Hyde Park, and the Zucker School of Medicine, Uniondale, New York; and the Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina.
Obstet Gynecol. 2025 May 22;146(1):94-103. doi: 10.1097/AOG.0000000000005945.
To describe the current and future use of vaginal hysterectomy in the United States for benign indications.
In this retrospective cohort study using data from the PINC AI Healthcare Database, we analyzed patients who underwent hysterectomy for benign indications from 2006 to 2020. Hysterectomy was classified as abdominal, vaginal, or minimally invasive (laparoscopic or robotic-assisted). Demographic and clinical characteristics, as well as surgeon and hospital characteristics and practice settings associated with the performance of vaginal hysterectomy, were estimated using multivariable models. To examine trends in the route of hysterectomy for benign indications, we plotted a trajectory to 2030 estimated from the vector autoregressive moving average processes model.
A total of 1,558,107 patients-including 852,356 (54.7%) who underwent minimally invasive hysterectomy, 472,234 (30.3%) who underwent abdominal hysterectomy, and 233,517 (15.0%) who underwent vaginal hysterectomy-were identified. The rate of vaginal hysterectomy declined from 22.6% in January 2006 to 8.3% in December 2020. Vaginal hysterectomy was more commonly performed in hospitals with a high volume of prolapse and incontinence cases and by surgeons who performed a high number of hysterectomies for prolapse and incontinence and who are high-volume. The rate of vaginal hysterectomy was projected to decline to 7.3% by January 2030. By January 2030, vaginal hysterectomy was estimated to be used in 11.9% of patients undergoing hysterectomy for prolapse and in 3.5% of hysterectomies for other indications. For all indications, a minimally invasive hysterectomy will be the most common route of surgery.
The performance of vaginal hysterectomy has declined substantially and is expected to fall to fewer than 8% of hysterectomies by 2030.
描述美国目前及未来因良性指征进行阴道子宫切除术的情况。
在这项回顾性队列研究中，我们使用PINC AI医疗数据库的数据，分析了2006年至2020年因良性指征接受子宫切除术的患者。子宫切除术分为腹部、阴道或微创（腹腔镜或机器人辅助）。使用多变量模型估计人口统计学和临床特征，以及与阴道子宫切除术实施相关的外科医生、医院特征和执业环境。为了研究因良性指征进行子宫切除术的途径趋势，我们绘制了根据向量自回归移动平均过程模型估计的到2030年的轨迹。
共识别出1558107例患者，其中852356例（54.7%）接受了微创子宫切除术，472234例（30.3%）接受了腹部子宫切除术，233517例（15.0%）接受了阴道子宫切除术。阴道子宫切除术的比例从2006年1月的22.6%下降到2020年12月的8.3%。阴道子宫切除术在脱垂和尿失禁病例数量较多的医院以及为脱垂和尿失禁进行大量子宫切除术且手术量较大的外科医生中更常进行。预计到2030年1月，阴道子宫切除术的比例将降至7.3%。到2030年1月，估计1有1.9%因脱垂接受子宫切除术的患者和3.5%因其他指征接受子宫切除术的患者会采用阴道子宫切除术。对于所有指征，微创子宫切除术将是最常见的手术途径。
阴道子宫切除术的实施率已大幅下降，预计到2030年将降至子宫切除术的8%以下。
