by more than 40% over the last decade. The study was conducted by researchers affiliated with Columbia University (New York, NY) and was published in the August 2013 edition of the journal Obstetrics and Gynecology
The researchers note that hysterectomy is one of the most commonly performed surgical procedures in women. An estimated one of nine women will undergo hysterectomy during their lifetime and approximately 600,000 procedures are performed each year in the US. A hysterectomy is commonly performed for most gynecologic malignancies; however, most hysterectomies are performed for benign gynecologic disease. Over the past decade, a number of national trends have had a strong influence on the practice of surgery. First, there has been great interest in conservative, nonsurgical treatments for many diseases. In gynecology, uterine artery embolization has been introduced for the treatment of fibroid tumors and nonsurgical treatments and ablative therapies (removal of uterine lining) are now commonly used for abnormal bleeding. In addition, more conservative treatment is now often used for women with cervical dysplasia and uterine-sparing procedures are increasingly used for genital tract malignancies and minimally invasive surgical techniques have been introduced for many procedures.
Vaginal hysterectomy has been performed for decades; however, laparoscopically assisted hysterectomy and total laparoscopic hysterectomy have been used since the 1990s and, more recently, robotic-assisted hysterectomy has been described. The study authors note that minimally invasive approaches to hysterectomy offer many advantages and may be performed as outpatient procedures. Another factor impacting the hysterectomy rate in many hospitals is an increased referral of high-risk patients and those that require specialized procedures to high-volume facilities and centers of excellence such as Ronald Reagan UCLA Medical Center.
The researchers note that, to date, little is known about how these changing trends have influenced hysterectomy rates. Therefore, they conduction a population-based analysis to determine the use of inpatient hysterectomy and explored changes in the use of various routes of hysterectomy and patterns of referral. The researchers accessed data from the Nationwide Inpatient Sample to identify all women aged 18 years or older who underwent an 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.
The researchers 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: fibroid tumors (−47.6%), abnormal bleeding (−28.9%), benign ovarian mass (−63.1%), endometriosis (−65.3%), and pelvic organ prolapse (−39.4%). The average hospital case volume decreased from 83 procedures per year in 2002 to 50 cases per year in 2010.
The researchers concluded that the number of inpatient hysterectomies performed in the United States has declined substantially over the past decade. The average number of hysterectomies per hospital has declined likewise by more than 40%.