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Nationwide trends in the performance of inpatient hysterectomy in the United States

Wright JD, Herzog TJ, Tsui J, Ananth CV, Lewin SN, Lu YS, Neugut AI, Hershman DL

Published August 2013 Obstetrics and gynecology
DOI 10.1097/AOG.0b013e318299a6cf PMID 23969789 PMC PMC3913114

RRM Academy Synopsis

US inpatient hysterectomies fell 36.4% from 2002 to 2010

U.S. inpatient hysterectomies fell 36.4% from their 2002 peak to 2010, a national discharge-database analysis found among women aged 18 and older who had the operation. The database samples about 20% of U.S. hospital discharges and spans 1998 to 2010. Hysterectomies for endometriosis fell 65.3% over the same years.

Study at a glance, national database study: US inpatient hysterectomies fell 36.4% from 2002 to 2010
Study at a glance, national database study of women aged 18 and older: US inpatient hysterectomies fell 36.4% from 2002 to 2010. Source: Wright JD et al., 2013, PMID 23969789.

Key Findings

  • Annual inpatient hysterectomies climbed from 543,812 in 1998 to a 2002 peak of 681,234, then declined each year to 433,621 in 2010, which is 36.4% below 2002.
  • From 2002 to 2010, hysterectomies for endometriosis fell 65.3% (239,844 to 83,158 operations) and those for leiomyoma (uterine fibroids) fell 47.6% (373,629 to 195,735).
  • Over the same years, hysterectomies for benign ovarian mass fell 63.1%, pelvic organ prolapse 39.4% and abnormal bleeding 28.9%. Gynecologic cancer procedures remained relatively stable from 1998 to 2010.
  • The median hospital performed 83 hysterectomies per year in 2002 and 50 in 2010 (P<.001).
  • Abdominal hysterectomy accounted for 68.9% of procedures in 2002 and 54.2% in 2010, while robotic hysterectomy rose from 0.9% to 8.2% between 2008 and 2010.

Interpretation

This national database study tracked U.S. inpatient hysterectomies from 1998 to 2010, weighted to national counts. The authors point to more less-invasive options. They also point to more nonsurgical care. Both likely drove the decline. The authors note the database misses same-day surgery. Their counts likely undercount laparoscopic and robotic cases. The trend invites further study of why women and physicians chose fewer, less invasive hysterectomies.

RRM Context

Endometriosis fell the most among the surgery reasons tracked. The authors point to new drug therapy for pain as one factor. Those drugs include birth control pills, a suppressive medication. Restorative reproductive medicine treats the cause. Excision is its surgical standard.

Our editorial summary of this paper, not the article's abstract.

Abstract

Objective

To examine the use of inpatient hysterectomy and explore changes in the use of various routes of hysterectomy and patterns of referral.

Methods

The Nationwide Inpatient Sample was used to identify all women aged 18 years or older who underwent inpatient hysterectomy between 1998 and 2010. Weighted estimates of national trends were calculated and the number of procedures performed estimated. Trends in hospital volume and across hospital characteristics were examined.

Results

After weighting, we identified a total 7,438,452 women who underwent inpatient hysterectomy between 1998 and 2010. The number of hysterectomies performed annually rose from 543,812 in 1998 to a peak of 681,234 in 2002; it then declined consistently annually and reached 433,621 cases in 2010. Overall, 247,973 (36.4%) fewer hysterectomies were performed in 2010 compared with 2002. From 2002 to 2010 the number of hysterectomies performed for each of the following indications declined: leiomyoma (-47.6%), abnormal bleeding (-28.9%), benign ovarian mass (-63.1%), endometriosis (-65.3%), and pelvic organ prolapse (-39.4%). The median hospital case volume decreased from 83 procedures per year in 2002 to 50 cases per year in 2010 (P<.001).

Conclusion

The number of inpatient hysterectomies performed in the United States has declined substantially over the past decade. The median number of hysterectomies per hospital has declined likewise by more than 40%.

Level of Evidence

III.

By this author

Related research

Jason D Wright, Thomas J Herzog, Jennifer Tsui, Cande V Ananth, Sharyn N Lewin, Yu-Shiang Lu, Alfred I Neugut, Dawn L Hershman
J Wright, Tom Herzog, T Herzog, Jen Tsui, Jenny Tsui, J Tsui, C Ananth, S Lewin, Y Lu, A Neugut, D Hershman
PMID 23969789 23969789 DOI 10.1097/AOG.0b013e318299a6cf 10.1097/AOG.0b013e318299a6cf Wright et al. 2013, Wright 2013

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