1
|
Siringo NV, Boczar D, Berman ZP, Chaya BF, Kimberly L, Rodriguez Colon R, Trilles J, Brydges H, Rodriguez ED. Gender-affirming hysterectomy in the United States: A comparative outcomes analysis and potential implications for uterine transplantation. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2023; 55:222-228. [PMID: 37923702 DOI: 10.1363/psrh.12246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
PURPOSE Hysterectomy is a gynecological procedure sometimes performed as part of the gender-affirming process for transgender and gender-expansive patients assigned female at birth. Our goal was to compare surgical outcomes between patients undergoing gender-affirming hysterectomy and patients undergoing hysterectomy for benign menstrual disorders. We then explored the implications of gender-affirming hysterectomy for uterine transplantation. METHODS We performed a retrospective cohort study using data from the American College of Surgeons National Surgical Quality Improvement Program database from 2009 through 2018. We identified patients undergoing hysterectomy in the United States based on Current Procedural Terminology code. We used the International Classification of Diseases 9 or 10 codes to identify patients with benign menstrual disorders (non-gender-affirming group) and gender dysphoria (gender-affirming group). We compared patient characteristics and surgical complications. RESULTS Of the 40,742 patients that met inclusion criteria, 526 (1.3%) patients were individuals with gender dysphoria. Compared to patients who underwent hysterectomy for benign menstrual disorders, gender-affirming patients were younger, were healthier, had a lower prevalence of diabetes, and were more likely to undergo surgery in the outpatient setting, with shorter time to discharge. Complication rates were similar between groups. Logistic regression controlling for the American Society of Anesthesiology classification determined the difference of return to the operating room was not statistically significant (OR 1.082; 95% CI, 0.56-2.10; p = 0.816). CONCLUSION Gender-affirming hysterectomy has a safety profile similar to hysterectomy performed for benign menstrual disorders. Researchers should further explore the possibility of uterus donation among these patients as they may be suitable candidates.
Collapse
Affiliation(s)
- Nicolette V Siringo
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
| | - Daniel Boczar
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
| | - Zoe P Berman
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
| | - Bachar F Chaya
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
| | - Laura Kimberly
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
- Division of Medical Ethics, Department of Population Health, New York University Langone Health, New York, New York, USA
| | - Ricardo Rodriguez Colon
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
| | - Jorge Trilles
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
| | - Hilliard Brydges
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
| | - Eduardo D Rodriguez
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York, USA
| |
Collapse
|
2
|
Chen CC, Peng IT, Wu MP. The Pros and Cons of Hystero-preservation on Pelvic Reconstructive Surgery. Gynecol Minim Invasive Ther 2023; 12:203-210. [PMID: 38034113 PMCID: PMC10683956 DOI: 10.4103/gmit.gmit_21_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 02/24/2023] [Accepted: 03/02/2023] [Indexed: 12/02/2023] Open
Abstract
In the "boat at the dock" theory, pelvic organ prolapse (POP) may happen when the ropes (uterine supportive ligaments) break and/or the water level drops (pelvic floor muscles). Thus, it causes the boat (uterus and other pelvic organs) to slip from normal position and protrude out of the vagina. Surgical intervention with or without hysterectomy (hystero-preservation) is the most effective treatment for POP. Both hysterectomy and hystero-preservation for POP had a high anatomic and clinical cure rate. There is an increasing trend of hystero-preservation for POP during the past decades. The choices of either hysterectomy or hystero-preservation depend on the surgical factors, psychosocial factors, self-esteem and sexuality factors, and surgeon factors. Pelvic reconstructive surgery, either hysterectomy or hystero-preservation, can be performed via different approaches, including abdominal, laparoscopic, and vaginal routes, with native tissue or with mesh. This review will elucidate their related pros and cons, with further discussion and comparison of hystero-preservation via different routes.
Collapse
Affiliation(s)
- Chin-Chiu Chen
- Department of Education, Taichung Veterans General Hospital, Taichung, Taiwan
| | - I-Ting Peng
- Division of Obstetrics, Department of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan, Taiwan
| | - Ming-Ping Wu
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
| |
Collapse
|
3
|
Lin SJ, Wu CY, Tsai CF, Yang HY. Hysterectomy and risk of osteoarthritis in women: a nationwide nested case-control study. Scand J Rheumatol 2023; 52:556-563. [PMID: 36644967 DOI: 10.1080/03009742.2022.2153985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/29/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Hysterectomy is the most common gynaecological surgery, performed mainly for benign uterine pathologies in women. Studies have suggested that hysterectomy is associated with osteoarthritis (OA); however, the association remains controversial. This study aimed to investigate the association between hysterectomy and the risk of OA. METHOD We performed a population-based nested case-control study using the National Health Insurance programme database from 2000 to 2016 in Taiwan. All medical conditions for each case and control were categorized using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10. A multiple conditional logistic regression model was applied to analyse the adjusted odds ratio (aOR) and 95% confidence interval (CI) for the association between hysterectomy and OA. RESULTS Our analyses included 16 592 patients with OA and 66 368 matched controls. After adjustment for possible confounders, hysterectomy had a significant association with OA (aOR = 1.19, 95% CI = 1.09-1.30), especially knee OA (aOR = 1.25, 95% CI = 1.13-1.38). Furthermore, women who received oestrogen therapy (ET) alone and patients who underwent hysterectomy without ET showed a greater risk of OA development compared to women who did not receive ET (aOR = 1.14, 95% CI = 1.07-1.23, and aOR = 1.19, 95% CI = 1.08-1.31, respectively). CONCLUSION Our findings indicate that hysterectomy is associated with OA, especially knee OA. We also found that women who received ET alone and patients who underwent hysterectomy without ET had an increased risk of OA.
Collapse
Affiliation(s)
- S-J Lin
- Department of Obstetrics and Gynecology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - C-Y Wu
- Department of Orthopedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
- Department of Nursing, Chung Jen Junior College of Nursing, Health Science and Management, Chia-Yi, Taiwan
| | - C-F Tsai
- Department of Medical Research, Clinical Data Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - H-Y Yang
- Department of Medical Research, Clinical Data Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| |
Collapse
|
4
|
Lin CH, Long CY, Huang KH, Lo TS, Wu MP. Surgical Trend and Volume Effect on the Choice of Hysterectomy Benign Gynecologic Conditions. Gynecol Minim Invasive Ther 2021; 10:1-9. [PMID: 33747766 PMCID: PMC7968603 DOI: 10.4103/gmit.gmit_68_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/11/2020] [Accepted: 09/03/2020] [Indexed: 11/04/2022] Open
Abstract
With the advance of minimally invasive surgery (MIS), the surgical trends of hysterectomy changed significantly during past 2 decades. Total number (age-standardized) of all types of hysterectomy decreased, which may be due to the availability of some other alternatives, e.g. hysteroscopy, laparoscopic myomectomy. However, laparoscopic hysterectomy (LH) still remains the mainstream of surgical treatment. LH significantly increases for benign gynecologic conditions in Taiwan and worldwide. The increase of LH was accompanied with decrease of TAH; VH kept stationary, and SAH increased slightly. The increase in popularity of LH and SAH; provides evidence of surgical trends and a paradigm shift for hysterectomy. This time-frame shift suggests LH has reached a u during the later years. Older patients tend to receive AH, while middle-aged women tend to receive LH. Oder surgeons tend to perform AH, while younger surgeons tend to perform LH. However, all type hysterectomy and LH were more commonly performed by older surgeons aged over 50 years. It means both patients and surgeons became older during the time-frames. The above phenomena may also happen due to less young surgeons entered in the gynecologic practice. Most of the LHs were performed by high-volume surgeons, however, there is a shift from high-volume, to medium- and low-volume surgeons. The above scenario may be due to the wide spread of LH techniques. Surgical volume has important impacts on both complications and costs. The high-volume surgeons have lower complications, which result in lower costs. In the future, how to increase the use of LH, to improve the training and monitoring system deserves more attentions.
Collapse
Affiliation(s)
- Chung-Hong Lin
- Department of Obstetrics and Gynecology, Chi Mei Hospital, Chiali, Taiwan.,Division of Urogynecology, Department of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan, Taiwan
| | - Cheng-Yu Long
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Obstetrics and Gynecology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuan-Hui Huang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Tsia-Shu Lo
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Ping Wu
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan, Taiwan.,Department of Obstetrics and Gynecology, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| |
Collapse
|
5
|
Chiang CH, Chen W, Tsai IJ, Hsu CY, Wang JH, Lin SZ, Ding DC. Diabetes mellitus risk after hysterectomy: A population-based retrospective cohort study. Medicine (Baltimore) 2021; 100:e24468. [PMID: 33530258 PMCID: PMC7850756 DOI: 10.1097/md.0000000000024468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 01/05/2021] [Indexed: 01/05/2023] Open
Abstract
We explored whether hysterectomy with or without bilateral oophorectomy was associated with the increasing incidence of diabetes mellitus (DM) in an East Asian population. This was a retrospective population-based cohort study that analyzed DM risk in Taiwanese women, using a health insurance research database of 1998 to 2013 containing nearly 1 million people. We identified 7088 women aged 30 to 49 years who had undergone hysterectomy with or without oophorectomy. The comparison group included 27,845 women without a hysterectomy who were randomly selected from the population and matched to women in the hysterectomy group by age (exact year) and year of the surgery. DM comorbidities were identified. The incidence and hazard ratios for DM were calculated with Cox proportional hazard regression models. The median ages of patients in the hysterectomy and comparison groups were both approximately 44 years. After a median 7.1 years of follow-up, the incidence of DM was 40% higher in the hysterectomized women as compared with the comparisons (9.12 vs 6.78/1000 person-years, P < .001), with an adjusted hazard ratio (aHR) of 1.37 (95% confidence interval [CI] = 1.23 -1.52). However, the DM risk was not increased in the women with hysterectomy plus oophorectomy (aHR=1.28, 95% CI = 0.93-1.76). Furthermore, among women aged 30 to 39 years, 40 to 49 years, the risk in hysterectomized women was higher than the comparisons (aHR = 1.75, 95% CI = 1.27-2.41; aHR = 1.33, 95% CI = 1.19-1.49, respectively). Our study provides essential and novel evidence for the association between hysterectomy and DM risk in women aged 30 to 49 years, which is relevant to these women and their physicians. Physicians should be aware of the increased DM risk associated with hysterectomy and take this into consideration when evaluating a patient for a hysterectomy. The current results might help gynecologists prevent DM and encourage diagnostic and preventive interventions in appropriate patients.
Collapse
Affiliation(s)
- Ching-Hsiang Chiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, and Tzu Chi University, Hualien
| | - Weishan Chen
- Management Office for Health Data, China Medical University Hospital
- College of Medicine, China Medical University, Taichung
| | - I-Ju Tsai
- Management Office for Health Data, China Medical University Hospital
- College of Medicine, China Medical University, Taichung
| | - Chung Y. Hsu
- College of Medicine, China Medical University, Taichung
| | | | - Shinn-Zong Lin
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation
| | - Dah-Ching Ding
- Institute of Medical Sciences
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Foundation, and Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
6
|
Yeh YT, Li PC, Wu KC, Yang YC, Chen W, Yip HT, Wang JH, Lin SZ, Ding DC. Hysterectomies are associated with an increased risk of osteoporosis and bone fracture: A population-based cohort study. PLoS One 2020; 15:e0243037. [PMID: 33259542 PMCID: PMC7707488 DOI: 10.1371/journal.pone.0243037] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/15/2020] [Indexed: 11/19/2022] Open
Abstract
AIM This study investigated the risk of osteoporosis or bone fractures (vertebrae, hip and others) in hysterectomized women in Taiwan. MATERIALS AND METHODS This is a retrospective population-based cohort study from 2000 to 2013. Women aged ≥30 years who underwent hysterectomy between 2000 and 2012 were included in this study. The comparison group was randomly selected from the database with a 1:4 matching with age and index year. Incidence rate and hazard ratios of osteoporosis and bone fracture between hysterectomized women and the comparison group were calculated. Cox proportional hazard regressions were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS We identified 9,189 hysterectomized women and 33,942 age-matched women without a hysterectomy. All women were followed for a median time of about 7 years. The adjusted hazard ratio (aHR) of subsequent osteoporosis or bone fracture was higher in the hysterectomy women (2.26, 95% confidence interval [CI] = 2.09-2.44) than in the comparison group. In the subgroup analysis, oophorectomy and estrogen therapy increase the risk of osteoporosis or fracture in both groups. Regarding the fracture site, the aHR of vertebral fracture (4.92, 95% CI = 3.78-6.40) was higher in the hysterectomized women than in the comparison group. As follow-up time increasing, the aHR of vertebral fracture in hysterectomized women were 4.33 (95% CI = 2.99-6.28), 3.89 (95% CI = 2.60-5.82) and 5.42 (95% CI = 2.66-11.01) for <5, 5-9 and ≥9 years of follow-up, respectively. CONCLUSIONS In conclusion, we found that hysterectomized women might be associated with increased risks of developing osteoporosis or bone fracture.
Collapse
Affiliation(s)
- Ying-Ting Yeh
- Department of Physical Medicine and Rehabilitation Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan
| | - Pei-Chen Li
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan
| | - Kun-Chi Wu
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan
| | - Yu-Cih Yang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Weishan Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Hei-Tung Yip
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Jen-Hung Wang
- Department of Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan
| | - Shinn-Zong Lin
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
- * E-mail:
| |
Collapse
|
7
|
Increased hypertension following hysterectomy among reproductive women in India. Am J Prev Cardiol 2020; 4:100131. [PMID: 34327482 PMCID: PMC8315321 DOI: 10.1016/j.ajpc.2020.100131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 11/16/2020] [Accepted: 11/19/2020] [Indexed: 01/16/2023] Open
Abstract
Background In recent years, hysterectomy has received increased attention in health policy debates in India. On the other hand, based non-communicable disease specific data for India, in 2011, WHO portray a grim picture and recommended to the government a 20% reduction in hypertension by 2020; however, the trends show that it is increasing. Yet, to date, there has not been a single nationally representative study of hypertension prevalence among women who undergo a hysterectomy. Methods The study has used the Indian fourth round of National Family Health Survey data, which is a cross-sectional nationally representative sample of 699,686 women in the age group 15–49 years and conducted during 2015–16. Bivariate and multivariate logistic regressions were used to examine the effect of hysterectomy on increased odds of hypertension among women of reproductive age groups. Results The age adjusted prevalence of hypertension was higher among women those who undergone hysterectomy (11.9%) compared to non-hysterectomy women (10.6%). The pattern holds true among relevant background characteristics such as age, place of residence, education, caste, religion, wealth, family size, years since hysterectomy, body mass index (BMI), anaemia and consumption of tobacco. The adjusted odds of hypertension among women who underwent hysterectomy compared to those who did not was 1.72 (95% CI: 1.14–2.58). Conclusions The results indicated increased hypertension level among hysterectomy women. However, these results are based on a cross-sectional study, and hence, further through investigation based on a prospective study is necessary before undertaking any policy changes. Meanwhile, the government of India may like to suggest surveillance to the general practitioners as well as obstetricians and gynaecologists following a hysterectomy in order to better understand the effect of hysterectomy on hypertension. Hysterectomy cases are increasing among pre-menopausal women in India. The prevalence of hypertension is higher among women who undergone hysterectomy. Controlling for the confounders did not change the higher prevalence of hypertension. The adjusted odds of hypertension is higher among hysterectomy women.
Collapse
|
8
|
Chen YC, Oyang YJ, Lin TY, Sun WZ. Risk assessment of dementia after hysterectomy: Analysis of 14-year data from the National Health Insurance Research Database in Taiwan. J Chin Med Assoc 2020; 83:394-399. [PMID: 32149891 DOI: 10.1097/jcma.0000000000000286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Anesthesia and surgery may increase the risk of dementia in the elderly, but the higher prevalence of dementia in women and other evidence suggest that dementia risk increases in younger women undergoing hysterectomy. In this study, we assessed the risk of dementia after hysterectomy. METHODS Hysterectomies registered in the National Health Insurance Research Database from 2000 to 2013 were evaluated using a retrospective generational research method. Multivariate Cox regression analysis was used to assess the effect of age at surgery, anesthesia method, and surgery type on the hazard ratio (HR) for the development of dementia. RESULTS Among 280 308 patients who underwent hysterectomy, 4753 (1.7%) developed dementia. Age at surgery and anesthesia method were associated with the occurrence of dementia, independent of surgery type. Among patients 30-49 years of age, general anesthesia (GA) was associated with a higher risk of dementia than spinal anesthesia (SA). The HR for GA was 2.678 (95% confidence interval [CI] = 1.269-5.650) and the risk of dementia increased by 7.4% for every 1-year increase in age (HR = 1.074; 95% CI = 1.048-1.101). In patients >50 years of age, the HR for GA was 1.206 (95% CI = 1.057-1.376), and the risk of dementia increased by 13.0% for every 1-year increase in age (HR = 1.130; 95% CI = 1.126-1.134). CONCLUSION The risk of dementia in women who underwent hysterectomy was significantly affected by older age at surgery, and the risk might not increase linearly with age, but show instead an S-curve with exponential increase at about 50 years of age. Although less significant, GA was associated with higher risk than SA, and the effect of the anesthesia method was greater in patients <50 years of age. In contrast, the surgical procedure used was not associated to the risk of dementia.
Collapse
Affiliation(s)
- Yi-Chun Chen
- Department of Anesthesiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Yen-Jen Oyang
- Graduate Institute of Biomedical Electronics and Bioinformatics, College of Electrical Engineering & Computer Science, National Taiwan University, Taipei, Taiwan, ROC
| | - Tzu-Yun Lin
- Department of Anesthesiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Wei-Zen Sun
- Graduate Institute of Biomedical Electronics and Bioinformatics, College of Electrical Engineering & Computer Science, National Taiwan University, Taipei, Taiwan, ROC
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan, ROC
| |
Collapse
|
9
|
Shen YC, Chen W, Tsai IJ, Wang JH, Lin SZ, Ding DC. Association of hysterectomy with bipolar disorder risk: A population-based cohort study. Depress Anxiety 2019; 36:543-551. [PMID: 31025812 DOI: 10.1002/da.22904] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/17/2019] [Accepted: 04/10/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hormonal fluctuations may trigger the onset of bipolar disorder. We designed a longitudinal follow-up study to evaluate the association between hysterectomies and bipolar disorder risk. METHODS We conducted a large retrospective cohort study using Taiwan's National Health Insurance Research Database. A total of 4,337 women aged 30 to 50 years who underwent the hysterectomy during 2000-2013 were selected and 17,348 patients without hysterectomy were selected for comparison (1:4 match). Poisson regression analysis was used to calculate the incidence rate ratio (IRR) and 95% confidence interval (CI). RESULTS During the follow-up of 7.93 years, 20 participants with hysterectomy and 28 without hysterectomy developed bipolar disorder. Receiving hysterectomy was associated with the risk of developing bipolar disorder (adjusted IRR = 2.80; 95% CI = 2.54-3.09). Women with hysterectomy had a higher risk of bipolar disorder in follow-up durations of <1 year (adjusted IRR = 2.18 with 95% CI = 1.94-1.45) and ≥1 year (adjusted IRR = 2.85 with 95% CI = 2.58-3.15). Endometriosis and Premarin use increased bipolar disorder incidence in the hysterectomy group (adjusted IRR = 3.17 [95% CI = 2.83-3.56] and 4.22 [95% CI = 3.71-4.80], respectively). CONCLUSION This study concluded that women with hysterectomy have an increased risk of bipolar disorder. Endometriosis and hormone therapy may add to the risk of bipolar disorder after hysterectomy. Knowledge about how surgical or natural hormonal withdrawal influences mood is fundamental and emphasizes the importance of coordinated psychiatric and gynecological care.
Collapse
Affiliation(s)
- Yu-Chih Shen
- Department of Psychiatry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan
| | - Weishan Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - I-Ju Tsai
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Jen-Hung Wang
- Department of Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan
| | - Shinn-Zong Lin
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
10
|
Huang CC, Lo TS, Huang YT, Long CY, Law KS, Wu MP. Surgical Trends and Time Frame Comparison of Surgical Types of Hysterectomy: A Nationwide, Population-based 15-year Study. J Minim Invasive Gynecol 2019; 27:65-73.e1. [PMID: 30928611 DOI: 10.1016/j.jmig.2019.02.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/25/2019] [Accepted: 02/04/2019] [Indexed: 12/16/2022]
Abstract
STUDY OBJECTIVE To investigate the surgical trends among different types of hysterectomy (abdominal, vaginal, laparoscopic, and subtotal) over a 15-year period in Taiwan. DESIGN A retrospective cohort study. SETTING A population-based National Health Insurance Research Database. PATIENTS Women undergoing various types of hysterectomy for noncancerous lesions. INTERVENTIONS Data for this study were extracted from the inpatient expenditures by admissions files of Taiwan's National Health Insurance Research Database from 1998 through 2012 and divided into three 5-year time frames: first (1998-2002), second (2003-2007), and third (2008-2012). The variables included types of hysterectomy, patient age, gynecologist age and sex, hospital accreditation level, and surgical volume. Chi-square and trend tests were used to examine the association between the variables. MEASUREMENTS AND MAIN RESULTS A total of 329 438 patients who underwent various types of hysterectomy were identified; 306 257 were included in the study. During the 15-year period, 45% underwent total abdominal hysterectomy, 41% underwent laparoscopic hysterectomy (LH), 9.8% underwent vaginal hysterectomy, and 4.2% underwent subtotal abdominal hysterectomy. The frequency of LHs increased from 35.9% in the first period to 43.9% in the second period and remained at 44.2% in the third period. During the same time period, there was a decrease in the frequency of total abdominal hysterectomies. Typically, younger patients underwent LHs by gynecologists with large volume surgical practices and medical centers. CONCLUSION This 15-year study describes an increase of LHs and subtotal abdominal hysterectomies over time and provides evidence of surgical trends and a paradigm shift of hysterectomies. Surgical skills and performance extended from high- to low-surgical volume gynecologists and from medical centers to regional and local hospitals. This shift may have a great influence on patient and health care provider choice of treatment.
Collapse
Affiliation(s)
- Chun-Che Huang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan (Dr C.-C. Huang)
| | - Tsia-Shu Lo
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung General Hospital, Keelung, Taiwan (Dr. Lo); School of Medicine, Chang Gung University, Taoyuan, Taiwan (Dr. Lo)
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan (Dr. Y.-T. Huang)
| | - Cheng-Yu Long
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan (Dr. Long); Department of Obstetrics and Gynecology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (Dr. Long)
| | - Kim-Seng Law
- Department of Obstetrics and Gynecology, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan (Dr. Law)
| | - Ming-Ping Wu
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, Tainan, Taiwan (Dr. Wu); Department of Obstetrics and Gynecology, College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan (Dr. Wu).
| |
Collapse
|
11
|
Lin YC, Hsu HK, Lai TS, Chiang WC, Lin SL, Chen YM, Chen CC, Chu TS. Emergency department utilization and resuscitation rate among patients receiving maintenance hemodialysis. J Formos Med Assoc 2019; 118:1652-1660. [PMID: 30711255 DOI: 10.1016/j.jfma.2019.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/03/2019] [Accepted: 01/09/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND End-stage renal disease (ESRD) is a growing global health concern with increased disease burden and high medical costs. Utilization of the emergency department (ED) among dialyzed patients and the associated risk factors remain unknown. METHODS Participants of this study, selected from the National Health Insurance Database in Taiwan, were aged 19-90 years and received maintenance hemodialysis from January 1, 2010, to December 31, 2010. A control group consisting of individuals who did not receive dialysis, selected from the same data source, were matched for age, sex, and the Charlson Comorbidity Index (CCI). Subgroup analysis with hemodialysis frequency was also performed. ED utilization among enrolled individuals was assessed in 2012. Generalized estimating equations with multiple variable adjustments were used to identify risk factors associated with resuscitation during ED visits. RESULTS One group of 2985 individuals who received maintenance hemodialysis, and another group of 2985 patients that did not receive hemodialysis, between January 1, 2010, and December 31, 2010, were included in this study. There were 4822 ED visits in the hemodialysis group, and 1755 ED visits in the non-dialysis group between January 1, 2012, and December 31, 2012. Analysis of multivariable generalized estimating equations identified the risk associated with resuscitation during ED visits to be greater in individuals who were receiving maintenance hemodialysis, aged older than 55 years, hospitalized in the past year, and assigned first and second degree of triage. CONCLUSION Patients receiving maintenance hemodialysis had higher ED utilization and a significantly higher risk of resuscitation during ED visits than those without hemodialysis.
Collapse
Affiliation(s)
- Yi-Chih Lin
- Department of Medicine, National Taiwan University Hospital Jinshan Branch, New Taipei City, Taiwan
| | - Hua-Kuei Hsu
- Department of Health Care Management, National Taipei University of Nursing and Health Science, Taipei, Taiwan
| | - Tai-Shuan Lai
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Wen-Chih Chiang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shuei-Liong Lin
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yung-Ming Chen
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chu-Chieh Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Science, Taipei, Taiwan.
| | - Tzong-Shinn Chu
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
12
|
Hysterectomy associated with de novo lower urinary tract symptoms in a Taiwanese population: a nationwide, population-based study. Int Urogynecol J 2018; 30:1711-1717. [DOI: 10.1007/s00192-018-3796-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/15/2018] [Indexed: 12/18/2022]
|
13
|
Hysterectomies Are Associated with an Increased Risk of Depression: A Population-Based Cohort Study. J Clin Med 2018; 7:jcm7100366. [PMID: 30340333 PMCID: PMC6210125 DOI: 10.3390/jcm7100366] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 01/11/2023] Open
Abstract
Using the National Health Insurance Research Database of Taiwan, we investigated whether undergoing a hysterectomy increases the risk of depression. A total of 7872 patients aged 30–49 years who underwent a hysterectomy from 2000 to 2013 were enrolled as the hysterectomy group. The comparison group was randomly selected from women who had never undergone a hysterectomy and was four times the size of the hysterectomy group. We calculated adjusted hazard ratios and 95% confidence intervals (CIs) for depression [The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 296.2, 296.3, 300.4, 311] in these cohorts after adjusting for age, comorbidities, oophorectomy, and hormone therapy. The overall incidence of depression was 1.02 and 0.66 per 100 person-years in the hysterectomy and comparison cohorts, respectively, yielding an adjusted hazard ratio of 1.35 (95% CI = 1.22–1.50) for depression risk. When we stratified patients by age, comorbidities, oophorectomy, and hormone use, hysterectomy increased the risk of depression. Hysterectomy, oophorectomy, and post-surgery hormone use were associated with an increased risk of depression when they occurred alone, but conferred a greater risk if they were considered jointly. Hysterectomy would be a predisposing factor for increased risk of subsequent depression. Our findings provide vital information for patients, clinicians, and the government for improving the treatment strategy in the future.
Collapse
|
14
|
Ding DC, Tsai IJ, Hsu CY, Wang JH, Lin SZ, Sung FC. Risk of hypertension after hysterectomy: a population-based study. BJOG 2018; 125:1717-1724. [PMID: 29953717 DOI: 10.1111/1471-0528.15389] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2018] [Indexed: 01/06/2023]
Affiliation(s)
- D-C Ding
- Department of Obstetrics and Gynaecology; Hualien Tzu Chi Hospital; Tzu Chi Medical Foundation; Tzu Chi University; Hualien Taiwan
- Institute of Medical Sciences; Tzu Chi University; Hualien Taiwan
| | - I-J Tsai
- Management Office for Health Data; China Medical University Hospital; Taichung Taiwan
- College of Medicine; China Medical University; Taichung Taiwan
| | - CY Hsu
- Graduate Institute of Clinical Medical Science; China Medical University; Taichung Taiwan
| | - J-H Wang
- Department of Research; Hualien Tzu Chi Hospital; Tzu Chi Medical Foundation; Tzu Chi University; Hualien Taiwan
| | - S-Z Lin
- Department of Neurosurgery; Hualien Tzu Chi Hospital; Tzu Chi Medical Foundation; Tzu Chi University; Hualien Taiwan
| | - F-C Sung
- Management Office for Health Data; China Medical University Hospital; Taichung Taiwan
- Department of Health Services Administration; China Medical University; Taichung Taiwan
| |
Collapse
|
15
|
Huang HK, Ding DC. Pelvic organ prolapse surgery following hysterectomy with benign indication: a national cohort study in Taiwan. Int Urogynecol J 2018; 29:1669-1674. [PMID: 29923012 DOI: 10.1007/s00192-018-3689-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 06/06/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Hysterectomy and pelvic organ prolapse (POP) surgeries are two of the most common gynecologic surgeries conducted for benign conditions. This nationwide retrospective cohort study explored the risk of subsequent POP surgery following hysterectomy without simultaneous POP surgery. METHODS This study identified 7298 patients who underwent hysterectomy between January 1, 2000, and December 31, 2012, from the Taiwan National Health Insurance (NHI) Research Database. A comparison cohort was constructed comprising 29,192 age-matched patients who had not undergone hysterectomy. All hysterectomy and control patients were followed until they required POP surgery, withdrew from the NHI system, died, or December 31, 2012. Patients were excluded if they underwent POP surgery before or at the time of hysterectomy. RESULTS The adjusted hazard ratio (aHR) of subsequent POP surgery in subjects with hysterectomy was higher [2.60, 95% confidence interval (CI) 1.79-3.78] than that of controls during the follow-up period. Compared with patients who had not undergone hysterectomy, the highest risks of subsequent POP surgery was noted in those who had undergone vaginal hysterectomy (VH; HR 6.29, 95% CI 1.54-25.79) followed by those who underwent laparoscopy-assisted VH (LAVH; HR 3.77, 95% CI 2.43-5.85). CONCLUSIONS Hysterectomy may increase the risk of subsequent POP surgery, and various hysterectomy techniques, particularly VH and LAVH, may increase the risk of subsequent POP surgery.
Collapse
Affiliation(s)
- Huei-Kai Huang
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan. .,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
| |
Collapse
|
16
|
Ding DC, Tsai IJ, Hsu CY, Wang JH, Lin SZ. Hysterectomy is associated with higher risk of coronary artery disease: A nationwide retrospective cohort study in Taiwan. Medicine (Baltimore) 2018; 97:e0421. [PMID: 29668602 PMCID: PMC5916687 DOI: 10.1097/md.0000000000010421] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Hysterectomy is a common procedure for benign pathologies of the uterus. Reduced production of estrogen following hysterectomy has been reported. Yet the association between hysterectomy and coronary artery disease (CAD) risk remains controversial. The aim of this study was to investigate the effect of hysterectomy on the risk of CAD; calculations were adjusted for traditional risk factors.This study used a 1 million patient cohort of the Taiwan National Health Insurance database and included a total of 7331 women who received hysterectomy from 2000 to 2013. We randomly selected a control group composed of 29,324 women without hysterectomy by 1:4 matching the age (exact year) with the hysterectomy group.The mean (standard deviation) age was 43.5 ± 4.0 in the hysterectomy and 43.6 ± 4.0 in the control group. A total of 1986 CAD cases developed in both groups during a median follow-up of 7 years. Significant differences were observed in CAD incidence in the hysterectomy versus control group (9.82 vs. 7.17/1000 person-years, P < .001, adjusted hazard ratio = 1.31 [95% confidence interval: 1.18-1.45]).We found a significant association between hysterectomy and CAD, even after adjustment for baseline CAD risk factors.
Collapse
Affiliation(s)
- Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
- Institute of Medical Sciences, Tzu Chi University, Hualien
| | - I-Ju Tsai
- Management Office for Health Data, China Medical University Hospital
| | - Chung Y. Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung
| | - Jen-Hung Wang
- Department of Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation
| | - Shinn-Zong Lin
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| |
Collapse
|
17
|
Okunade KS, Sekumade A, Daramola E, Oluwole AA. A 4-Year Clinical Review of Elective Hysterectomies at a University Teaching Hospital in Lagos, Nigeria. J Gynecol Surg 2017. [DOI: 10.1089/gyn.2017.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kehinde S. Okunade
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, South West, Nigeria
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, South West, Nigeria
| | - Adebayo Sekumade
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, South West, Nigeria
| | - Ebunoluwa Daramola
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, South West, Nigeria
| | - Ayodeji A. Oluwole
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, South West, Nigeria
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, South West, Nigeria
| |
Collapse
|
18
|
Ding DC, Chu TY, Hong MK. Hysterectomy and ovarian cystectomy using natural orifice transluminal endoscopic surgery: An initial experience at Tzu Chi General Hospital. Tzu Chi Med J 2017; 29:208-212. [PMID: 29296049 PMCID: PMC5740693 DOI: 10.4103/tcmj.tcmj_127_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/24/2017] [Accepted: 05/09/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The objective of this study is to report our initial experience with patients undergoing transvaginal natural orifice transluminal endoscopic surgery (NOTES). MATERIALS AND METHODS From September 2016 to December 2016, patients who were not virgins and did not have pelvic inflammation or obliteration of the cul-de-sac who underwent NOTES hysterectomy or ovarian cystectomy (OC) were included in the study. RESULTS Transvaginal NOTES was performed smoothly in six patients, two patients (mean age 35 years, mean body mass index [BMI] 25) received an OC and four patients (mean age 49 years, mean BMI 27) underwent a hysterectomy. One patient with a hysterectomy received concurrent adhesiolysis. The mean surgical times were 74 and 75 min and blood loss was 50 and 87.5 ml in the OC and hysterectomy groups, respectively. One patient with a hysterectomy had a postoperative fever with 38°C last for 2 days. Pain scores were 0 at 48 h postoperatively in both groups. CONCLUSION Transvaginal NOTES is a feasible and safe technique for hysterectomy and OC in our patients and those in previous reports. This procedure was minimally invasive with no scars on the abdomen as well as little pain.
Collapse
Affiliation(s)
- Dah-Ching Ding
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Tang-Yuan Chu
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Mun-Kun Hong
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
19
|
|
20
|
Huang CC, Huang YT, Chueh PJ, Wu MP. The laparoscopic approach is more preferred among nurses for benign gynecologic conditions than among nonmedical working women: A nationwide study in Taiwan. Taiwan J Obstet Gynecol 2017; 55:229-34. [PMID: 27125406 DOI: 10.1016/j.tjog.2015.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To compare the use of laparoscopy and laparotomy for hysterectomy in treating benign gynecological conditions in nurses and nonmedical working women. MATERIALS AND METHODS A nationwide population-based study was conducted using data from inpatient expenditures of Taiwan's National Health Insurance Research Datasets between 2008 and 2011. All women undergoing total hysterectomies via laparoscopy and laparotomy between the ages of 20 years and 65 years were identified. A generalized equation estimation model was used to compare the differences in laparoscopic hysterectomy (LH) and total abdominal hysterectomy (TAH) between the two groups. RESULTS There were 1226 nurses, and 36,624 nonmedical working women, serving as controls, in the present study. The LH rate, as compared to the TAH rate, was significantly higher among nurses than among controls (56% vs. 52%, p = 0.006). A multivariate analysis indicated that nurses were significantly more likely to undergo LH (odds ratio, 1.12; 95% confidence interval, 1.01-1.26) than TAH. Nurses were more often treated at medical centers or high-volume hospitals, and were more often treated by high-volume gynecologists. CONCLUSION Compared to nonmedical working women, nurses are more likely to undergo LH rather than TAH. These differences may suggest the influence of medical knowledge and physician-patient interaction on the decision to undergo laparoscopy, in addition to patients' medical conditions.
Collapse
Affiliation(s)
- Chun-Che Huang
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Yu-Tung Huang
- Master Degree Program in Aging and Long-Term Care, College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pei-Ju Chueh
- Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, Tainan, Taiwan
| | - Ming-Ping Wu
- Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, Tainan, Taiwan; Department of Obstetrics and Gynecology, College of Medicine, Taipei Medical University, Taipei, Taiwan; Center of General Education, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
| |
Collapse
|
21
|
Huang WY, Huang KH, Chang WC, Wu SC. Temporal trend and nationwide utility for hysterectomies in Taiwan, 1997-2010. Taiwan J Obstet Gynecol 2017; 55:659-665. [PMID: 27751412 DOI: 10.1016/j.tjog.2015.12.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study investigates the nationwide utilization and temporal trend of hysterectomies in Taiwan. MATERIALS AND METHODS The present study used the National Health Insurance Research Database that included claims of nearly the entire population in Taiwan since the inception of the National Health Insurance program in 1995. We analyzed age-adjusted rates of hysterectomies in Taiwan from 1997 through to 2010 and compared with the rates in 16 countries of the Organization for Economic Co-operation and Development. We also examined the utilization of various types of hysterectomies in Taiwan during this period. RESULTS There was a cross-country variation in the age-standardized rate of hysterectomy: 105 per 100,000 females in Spain, 156 per 100,000 females in Taiwan, 179 per 100,000 females in 16 Organization for Economic Co-operation and Development countries, and 325 per 100,000 females in the United States in 2008. The trend of the age-standardized rate of hysterectomy in Taiwan declined from 222.3 per 100,000 women in 1998 to 145.2 per 100,000 women in 2010. The most common type of hysterectomy during this period was total abdominal hysterectomy (51.2%). Subtotal hysterectomies increased by 117% (r2=0.89; p<0.01), from 672 in 1997 to 1458 in 2010; however, total hysterectomies decreased by 3.5% (r2=0.43; p=0.01), from 20,966 in 1997 to 20,230 in 2010. Laparoscopically assisted procedures (laparoscopic supracervical hysterectomy and laparoscopic hysterectomy) increased 4.98-fold (r2=0.23; p=0.09), from 1453 in 1997 to 8684 in 2010. By contrast, the proportion of conventional open hysterectomies (total abdominal hysterectomy, and subtotal or supracervical abdominal hysterectomy) decreased by 36.5% (r2=0.59; p<0.01), from 17,327 in 1997 to 10,994 in 2010. The proportion of vaginal hysterectomies decreased by 29.7% (r2=0.72; p<0.01), from 2858 in 1997 to 2010 in 2010. CONCLUSION As in most Western countries, hysterectomy rates in Taiwan declined by year. There was a marked shift in the types of hysterectomies from 1997 through to 2010 in Taiwan. Minimally invasive surgeries and supracervical hysterectomies were more commonly adopted.
Collapse
Affiliation(s)
- Wei-Yi Huang
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan; Research and Planning Division, Department of Health, Taipei City Government, Taiwan
| | - Kuo-How Huang
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Chun Chang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shiao-Chi Wu
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan.
| |
Collapse
|
22
|
Matsuo K, Machida H, Takiuchi T, Garcia-Sayre J, Yessaian AA, Roman LD. Prognosis of women with apparent stage I endometrial cancer who had supracervical hysterectomy. Gynecol Oncol 2017; 145:41-49. [PMID: 28215841 DOI: 10.1016/j.ygyno.2017.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 02/02/2017] [Accepted: 02/02/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To examine characteristics and survival outcomes of women with apparent early-stage endometrial cancer who had a supracervical hysterectomy. METHODS The Surveillance, Epidemiology, and End Results Program was used to identify women with presumed stage I endometrial cancer who underwent supracervical hysterectomy between 1983 and 2012. Propensity score matching was performed to adjust background difference between supracervical hysterectomy (n=1,339) and total hysterectomy (n=110,523) cases. Endometrial cancer-specific survival (CSS) was examined by multivariable analysis expressed with adjusted-hazard ratio [HR] and 95% confidence interval [CI]. RESULTS Supracervical hysterectomy was independently associated with younger age, low-grade disease, and small tumor size on multivariable analysis (all, P<0.001). After propensity score matching, supracervical hysterectomy remained an independent prognostic factor for decreased CSS compared to total hysterectomy (10-year rates, 91.0% versus 94.9%, adjusted-HR 1.72, 95%CI 1.20-2.47, P=0.003). Among women who received postoperative radiotherapy, 10-year CSS rates were similar between supracervical and total hysterectomy cases (84.7% versus 80.3%, P=0.40). Contrary, in the absence of postoperative radiotherapy, women undergoing supracervical hysterectomy had a significantly lower 10-year CSS rate compared to those undergoing total hysterectomy (92.1% versus 97.2%, P<0.001). Moreover, with lack of lymphadenectomy, supracervical hysterectomy was associated with decreased CSS compared to those who had total hysterectomy (91.6% versus 94.3%, P=0.018) but had similar CSS rates with lymphadenectomy (92.7% versus 91.8%, P=0.91). CONCLUSION Although rarely performed, supracervical hysterectomy is associated with decreased survival outcome among women with apparent stage I endometrial cancer supporting the importance of avoiding this procedure in women with or at risk of endometrial cancer.
Collapse
Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
| | - Hiroko Machida
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Tsuyoshi Takiuchi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Jocelyn Garcia-Sayre
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Annie A Yessaian
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
23
|
Hysterectomies in Portugal (2000-2014): What has changed? Eur J Obstet Gynecol Reprod Biol 2016; 208:97-102. [PMID: 27914240 DOI: 10.1016/j.ejogrb.2016.11.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/16/2016] [Accepted: 11/19/2016] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To describe conditions regarding hysterectomies during the past 15 years in Portugal. STUDY DESIGN Nationwide retrospective study of women who underwent hysterectomy in Portuguese public hospitals in the period between 2000 and 2014. Patient data regarding hospital codes, geography, patient age, indications, operative techniques, associated procedures, complications, admission dates, discharge dates and 30-day postoperative readmissions were extracted from the national database with information regarding all public hospitals in Portugal. For calculation of hysterectomy rates, the total number of women was found using the Statistics Portugal website. Data were analysed using STATA version 13.1. RESULTS A total of 166 177 hysterectomies were performed between 2000 and 2014 in public hospitals in Portugal. The overall rate of hysterectomy decreased 19.3% (from 212/100 000 to 171/100 000 women per year). The average age of women at time of hysterectomy increased from 51.6±11.4 to 55.2±12.3years (p<0.001). There was an increase in laparoscopic [1.2%-9.5%, p<0.001] and vaginal route [13.3%-21.2%, p<0.001], with a consequent decrease in laparotomic route [85.5%-69.1%, p<0.001]. There was a change in the pattern of indications for hysterectomy; however, uterine fibroids remain the major indication for hysterectomy [45.3%-37.6%, p<0.001]. In women with hysterectomy for benign pathology, the rate of bilateral adnexectomy decreased from 71.0% to 51.9% (p<0.001) and the rate of bilateral salpingectomy increased from 1.0% to 15.1% (p<0.001). The mean number of hospitalization days decreased from 7.1±6.1 (in 2000-2004) to 5.4±5.0 (in 2010-2014) (p<0.001). Globally, the rate of complications increased from 3.3% in 2000-2004 to 3.6% in 2010-2014 (p<0.01). CONCLUSION In Portugal, the rate of hysterectomies decreased in the last 15 years with an increase in age at the time of the procedure and a change towards less invasive routes. Uterine fibroids remain the major indication for hysterectomy. Additionally, we noted a significant shift towards more concomitant bilateral salpingectomy (and less bilateral adnexectomy) during hysterectomy for benign indications, according to the evidence suggesting the fallopian tube as the origin of ovarian cancer.
Collapse
|
24
|
In-hospital complications of vaginal versus laparoscopic-assisted benign hysterectomy among older women: a propensity score-matched cohort study. Menopause 2016; 23:1233-1238. [PMID: 27465711 DOI: 10.1097/gme.0000000000000713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This investigation compared the outcomes of vaginal and laparoscopic hysterectomies for nonprolapsed benign indications in older women. METHODS We conducted a population-based, retrospective propensity score-matched cohort study using data from the Taiwan's National Health Insurance program. Women who were aged 65 years or older with vaginal hysterectomy (n = 290) were compared with women who had laparoscopic hysterectomy for nonprolapsed benign indications (n = 290). Propensity score was calculated based on both patient- (age, socioeconomic status, residential urbanicity, comorbidity, status of any prior catastrophic illness, surgical diagnosis, and year of hysterectomy) and provider-related characteristics (physician's age and sex, hospital accreditation level, and ownership type). RESULTS Women undergoing laparoscopic hysterectomy were not associated with increased risk of inpatient readmission within 30 days, in-hospital mortality, and in-hospital (including intraoperative) complications when compared with those who had vaginal hysterectomy. Women in the laparoscopic group had significantly shorter hospital stays than those in the vaginal group. The bleeding complications were mostly due to blood transfusion (2.1% in vaginal and 0.7% in laparoscopic hysterectomy groups) and urinary tract infection (1.0% in vaginal and 1.7% in laparoscopic hysterectomy groups). The surgical injury (intraoperative) complications included mostly surgical laceration of the urinary tract (0.7% in vaginal and 0.3% in laparoscopic hysterectomy groups). CONCLUSIONS Advanced age alone should not be the limiting factor for surgical referral of laparoscopic hysterectomy. The shorter hospital stay and low in-hospital complications associated with laparoscopic, as opposed to vaginal hysterectomies, are important attributes of a surgical procedure essential to the postoperative care in older women aged 65 years or more.
Collapse
|
25
|
Lai JCY, Huang N, Huang SM, Hu HY, Wang CW, Chou YJ, Wang KL. Decreasing trend of hysterectomy in Taiwan: A population-based study, 1997-2010. Taiwan J Obstet Gynecol 2016; 54:512-8. [PMID: 26522101 DOI: 10.1016/j.tjog.2014.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2014] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Gynecologists in Taiwan are lacking a comprehensive picture of the changes in clinical practice and indications of hysterectomy over a long period of time. The aims of this study were to examine the national trends in the utilization of hysterectomy and to explore changes in its utilization rate over a 14-year period from 1997 to 2010. MATERIALS AND METHODS We conducted a population-based trend analysis using the claims data from the Taiwan's National Health Insurance program. RESULTS We identified a total of 341,993 women aged 20 years or older who underwent hysterectomy between 1997 and 2010. The total number of hysterectomies increased from 22,961 in 1997 to 27,757 cases in 1999, followed by a decline to 22,351 in 2010. Overall, 5406 fewer hysterectomies (-19.5%) were performed in 2010 when compared with those performed in 1999. The number of hysterectomies performed decreased from 1997 to 2010 for precancerous lesions (-55.6%), chronic pelvic pain (-35.2%), uterine leiomyoma (-13.1%), and uterine prolapse (-7.2%). However, the utilization of hysterectomy increased for endometriosis (+76.3%) and gynecologic cancer (+22.7%) during the same time frame. CONCLUSION The clinical utilization and primary indications of hysterectomy changed substantially in Taiwan from 1997 to 2010. The continued monitoring of changes in hysterectomy rates will be critical for understanding the appropriate indications for hysterectomy and oophorectomy, the emergence of alternative managements for uterine disorders, and future trends in women's reproductive health.
Collapse
Affiliation(s)
- Jerry Cheng-Yen Lai
- Institute of Public Health and Department of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Sheng-Miauh Huang
- Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
| | - Hsiao-Yun Hu
- Institute of Public Health and Department of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
| | - Chien-Wei Wang
- Department of Medicine, Medical University of Lublin, Lublin, Poland
| | - Yiing-Jenq Chou
- Institute of Public Health and Department of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Kung-Liahng Wang
- Department of Nursing, Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; Department of Obstetrics and Gynecology, Mackay Memorial Hospital and Mackay Medical College, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
26
|
Yusuf F, Leeder S, Wilson A. Recent estimates of the incidence of hysterectomy in New South Wales and trends over the past 30 years. Aust N Z J Obstet Gynaecol 2016; 56:420-5. [PMID: 27297684 DOI: 10.1111/ajo.12477] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 04/09/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hysterectomy remains one of the frequently used surgical operations on women in Australia despite new therapeutic approaches for most of the common conditions for which hysterectomy is indicated. AIMS To determine whether the surgical approach to hysterectomy has changed in New South Wales (NSW) over the period 1981 to 2010-2012. DATA AND METHODS De-identified individual records for hysterectomy patients during the three-year period (January 2010 to December 2012) provided by the NSW Ministry of Health were used. Robotic assistance with surgery was not recorded in the hysterectomy data. Analysis largely involved the method of indirect standardisation. RESULTS The average annual hysterectomy rate during 2010-2012 was 3.07 per 1000 females per annum; the majority of patients stayed an average of four days in hospital. Total abdominal and vaginal hysterectomies were the two most frequently used procedures. One-in-four procedures involved the use of laparoscopes. Principal diagnoses (in descending order) were disorders of menstruation and other abnormal bleeding, genital prolapse, leiomyoma of uterus, malignant neoplasm of genital organs and endometriosis. While declining trends in hysterectomy rates were noted since 1981, an increasing trend in the use of laparoscopy was evident. CONCLUSIONS The 45% decrease in hysterectomy rates was indeed the most striking finding of our analysis. This is probably due to the development of alternative nonsurgical procedures such as oral hormone suppression of menstruation and the levonorgestrel-releasing intrauterine system.
Collapse
Affiliation(s)
- Farhat Yusuf
- Menzies Centre for Health Policy, The University of Sydney, Sydney, New South Wales, Australia.,Department of Marketing & Management, Macquarie University, Sydney, New South Wales, Australia
| | - Stephen Leeder
- Menzies Centre for Health Policy, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrew Wilson
- Menzies Centre for Health Policy, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
27
|
Chou PH, Lin CH, Cheng C, Chang CL, Tsai CJ, Tsai CP, Lan TH, Chan CH. Risk of depressive disorders in women undergoing hysterectomy: A population-based follow-up study. J Psychiatr Res 2015; 68:186-91. [PMID: 26228418 DOI: 10.1016/j.jpsychires.2015.06.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 06/16/2015] [Accepted: 06/19/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to assess the risk of depressive disorders in women who underwent hysterectomy in Taiwan. METHODS A retrospective study was conducted in a matched cohort of cases using the National Health Insurance Research Database of Taiwan. Database records from 1689 women who underwent hysterectomy between 2001 and 2005 were included in this study. A control group matched for age and physical comorbidity was selected from the same database (n = 6752). For all cases, medical records were tracked until the end of 2009 to identify whether a depressive disorder was diagnosed during the follow-up period. The hazard ratio (HR) for depression during the observation period was analyzed using multivariable Cox proportional-hazards models, adjusted for age, physical comorbidities, and other socioeconomic factors. RESULTS The HR for depression was 1.78 times higher for the group that underwent hysterectomy than for the control group (adjusted HR = 1.78; 95% CI = 1.46-2.18, p < 0.001). In addition, HR for major depressive disorder in women who underwent hysterectomy was significantly higher (1.84 times) than for the control group (adjusted HR = 1.84; 95% CI = 1.23-2.74, p < 0.01). CONCLUSIONS Our study revealed that, in Taiwan, women who underwent hysterectomy had an increased risk of developing depression. Longitudinal studies to follow-up the psychological outcomes in Taiwanese women who underwent hysterectomy will be necessary to confirm our findings.
Collapse
Affiliation(s)
- Po-Han Chou
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
| | - Chin Cheng
- Department of Psychiatry, Chin Bing Hospital, Taichung, Taiwan
| | - Chia-Li Chang
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Jui Tsai
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ching-Pei Tsai
- Department of Gynecology and Obstetrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tsuo-Hung Lan
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Psychiatry, Faculty of Medicine, National Yang Ming University, Taipei, Taiwan.
| | - Chin-Hong Chan
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
| |
Collapse
|
28
|
Driessen SR, Baden NL, van Zwet EW, Twijnstra AR, Jansen FW. Trends in the Implementation of Advanced Minimally Invasive Gynecologic Surgical Procedures in The Netherlands. J Minim Invasive Gynecol 2015; 22:642-7. [DOI: 10.1016/j.jmig.2015.01.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 01/21/2015] [Accepted: 01/25/2015] [Indexed: 11/25/2022]
|
29
|
How surgical technology translates into practice: the model of laparoscopic liver resections performed in France. Ann Surg 2015; 260:916-21; discussion 921-2. [PMID: 25243552 DOI: 10.1097/sla.0000000000000950] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Analyze, at a national level, the adoption and practice of laparoscopic liver resections (LAP), compared to open resections (OPEN). BACKGROUND LAP initiated 20 years ago, has been described for all hepatectomies, and is considered as the reference technique for some resections. There are, however, no data on its adoption outside selected specialty centers. METHODS French Healthcare databases were screened to identify all patients who underwent an elective LAP or OPEN between 2007 and 2012. Patients' demographics, associated conditions, indication for surgery, hepatectomy performed, and hospital type and hepatectomy caseload were retrieved. Patients who had possible overcoding of biopsies as wedge resections were identified to select REAL resections. Time trend analyses were performed using a piecewise linear regression and the average annual percent change (AAPC) calculated. RESULTS There were 7881 (17.8%) LAP and 36,359 (82.2%) OPEN performed in an average of 483 hospitals. Of these, biopsies accounted for 29.9% of the LAP (7.3% of the OPEN, P<0.0001) and the incidence of LAP biopsies increased after 2009. The AAPC of the incidence of real LAP increased more than that of real OPEN (7.0% vs 1.3%) but most were minor resections (61.1% vs 28.9% for OPEN, P<0.0001), only 15% of patients were operated by LAP and intermediate (or major) resections were performed in 19.5% (or 4.8%) of hospitals performing liver resections. The proportion of resections performed by LAP was inversely related to annual caseload. The overall incidence of resections performed for benign conditions did not increase. CONCLUSIONS LAP is not developing, has not been adopted for intermediate/major resections, does not result in overuse for benign indications and some of the 2009 -consensus statements are not applied.
Collapse
|
30
|
Wu CJ, Tseng CW, Wu MP. Laparoscopic subtotal hysterectomy in the era of minimally invasive surgery. Gynecol Minim Invasive Ther 2015. [DOI: 10.1016/j.gmit.2014.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
31
|
Mascarenhas T, Mascarenhas-Saraiva M, Ricon-Ferraz A, Nogueira P, Lopes F, Freitas A. Pelvic organ prolapse surgical management in Portugal and FDA safety communication have an impact on vaginal mesh. Int Urogynecol J 2014; 26:113-22. [PMID: 25124092 DOI: 10.1007/s00192-014-2480-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 06/29/2014] [Indexed: 02/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse (POP) surgery has lately gained importance in gynecological practice. This study aims to characterize the evolution of POP surgical procedures conducted in Portugal in the last decade and the impact of an FDA 2011 safety communication on mesh POP surgeries. METHODS Trends in the surgical management of POP were assessed using the Portuguese National Medical Registry. We considered all records of women with diagnosis of genital prolapse from 1 January 2000 to 31 December 2012. Additionally, we also conducted a survey among members of the Portuguese Society of Urogynecology to evaluate current practices in the surgical management of POP. RESULTS From 2000 to 2012, 46,819 diagnoses of genital prolapse were registered, with a 105 % increase during the study period (2,368 in 2000 to 4,941 in 2012). POP mesh surgery represented only 6 % of total prolapse diagnoses, but mesh use greatly increased up to 2011, when only a slight increase was registered. Among gynecologists who responded to the questionnaire, there was considerable variability on the procedures of choice to treat POP. Fifty-seven per cent of respondents performed vaginal mesh POP surgery, but only 27 % of those actually reported having changed their practice after the FDA 2011 safety communication. CONCLUSIONS Surgical procedures for POP conducted in Portugal greatly increased over the last decade. The use of surgical meshes is still limited, but despite FDA safety communication it has increased over the years, with a slight increase in 2012, which illustrates the need for further analyses in the coming years.
Collapse
Affiliation(s)
- Teresa Mascarenhas
- Department of Gynecology and Obstetrics, Hospital S. João, Faculty of Medicine of Porto University, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal,
| | | | | | | | | | | |
Collapse
|
32
|
Pandey D, Yen CF, Lee CL, Wu MP. Electrosurgical technology: Quintessence of the laparoscopic armamentarium. Gynecol Minim Invasive Ther 2014. [DOI: 10.1016/j.gmit.2014.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
33
|
Hong MK, Wang JH, Chu TY, Ding DC. Laparoendoscopic single-site hysterectomy with Ligasure is better than conventional laparoscopic assisted vaginal hysterectomy. Gynecol Minim Invasive Ther 2014. [DOI: 10.1016/j.gmit.2014.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
|
34
|
|
35
|
Surgical trends for benign ovarian tumors among hospitals of different accreditation levels: An 11-year nationwide population-based descriptive study in Taiwan. Taiwan J Obstet Gynecol 2013; 52:498-504. [DOI: 10.1016/j.tjog.2013.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 11/22/2012] [Indexed: 11/20/2022] Open
|
36
|
Mäkinen J, Brummer T, Jalkanen J, Heikkinen AM, Fraser J, Tomás E, Härkki P, Sjöberg J. Ten years of progress--improved hysterectomy outcomes in Finland 1996-2006: a longitudinal observation study. BMJ Open 2013; 3:e003169. [PMID: 24165027 PMCID: PMC3816230 DOI: 10.1136/bmjopen-2013-003169] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To study the outcome of various hysterectomies in 2 years 1996 (N =10110) and 2006 (N=5279). The hypothesis was that the change in operative practices in 10 years has resulted in improvements. DESIGN 2 prospective nationwide cohort evaluations with the same questionnaire. SETTING All national operative hospitals in Finland. PARTICIPANTS Patients scheduled to either abdominal hysterectomy (AH), vaginal hysterectomy (VH) or laparoscopic hysterectomy (LH) for benign disease. OUTCOME MEASURES Patients' characteristics, surgery-related details and complications (organ injury, infection, venous thromboembolism and haemorrhage). RESULTS The overall complication rates fell in LH and markedly in VH (from 22.2% to 11.7%, p<0.001). The overall surgery-related infectious morbidity decreased in all groups and significantly in VH (from 12.3% to 5.2%, p<0.001) and AH (from 9.9% to 7.7%, p<0.05). The incidence of bowel lesions in VH sank from 0.5% to 0.1% and of ureter lesions in LH from 1.1% to 0.3%. In 2006 there were no deaths compared with three in 1996. CONCLUSIONS The rate of postoperative complications fell markedly in the decade from 1996 to 2006. This parallels with the recommendation of the recent meta-analyses by Cochrane collaboration; the order of preference of hysterectomies was for the first time precisely followed in this nationwide study. TRIAL REGISTRATION The 2006 study was registered in the Clinical Trials of Protocol Registration System Data (NCT00744172).
Collapse
Affiliation(s)
- Juha Mäkinen
- Department of Obstetrics and Gynecology, Turku University and Turku University Hospital, Turku, Finland
| | - Tea Brummer
- Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland
| | - Jyrki Jalkanen
- Department of Obstetrics and Gynecology, Central Finland (Jyväskylä) Central Hospital, Jyväskylä, Finland
| | - Anna-Mari Heikkinen
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland
| | - Jaana Fraser
- Department of Obstetrics and Gynecology, North Karelia (Joensuu) Central Hospital, Joensuu, Finland
| | - Eija Tomás
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Päivi Härkki
- Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland
| | - Jari Sjöberg
- Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
37
|
Yeh JS, Cheng HM, Hsu PF, Sung SH, Liu WL, Fang HL, Chuang SY. Hysterectomy in young women associates with higher risk of stroke: A nationwide cohort study. Int J Cardiol 2013; 168:2616-21. [DOI: 10.1016/j.ijcard.2013.03.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 01/01/2013] [Accepted: 03/17/2013] [Indexed: 10/27/2022]
|
38
|
Hsu PY, Long CY, Huang YT, Huang KH, Tang CH, Wu MP. The vicissitudes of open and laparoscopic retropubic urethropexy for stress urinary incontinence in Taiwan: An 11-year nationwide analysis. Gynecol Minim Invasive Ther 2013. [DOI: 10.1016/j.gmit.2012.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
39
|
Wu MP, Lee CL. The trends of minimally invasive surgery for benign gynecologic lesions, 1997-2007 in Taiwan. Gynecol Minim Invasive Ther 2012. [DOI: 10.1016/j.gmit.2012.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
40
|
Primary and Repeated Surgeries for Ectopic Pregnancies and Distribution by Patient Age, Surgeon Age, and Hospital Levels: An 11-Year Nationwide Population-Based Descriptive Study in Taiwan. J Minim Invasive Gynecol 2012; 19:598-605. [DOI: 10.1016/j.jmig.2012.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 05/06/2012] [Accepted: 05/22/2012] [Indexed: 11/18/2022]
|
41
|
Ding DC, Chu TY, Chang YH. Trend changes in the proportion of minimal invasive hysterectomies over a five-year period: A single-center experience. Tzu Chi Med J 2012. [DOI: 10.1016/j.tcmj.2012.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
42
|
Su H, Yen CF, Wu KY, Han CM, Lee CL. Hysterectomy via transvaginal natural orifice transluminal endoscopic surgery (NOTES): Feasibility of an innovative approach. Taiwan J Obstet Gynecol 2012; 51:217-21. [PMID: 22795097 DOI: 10.1016/j.tjog.2012.04.009] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2012] [Indexed: 11/27/2022] Open
|
43
|
Huang CC, Wu MP, Huang YT. Gynecologists' characteristics associated with the likelihood of performing laparoscopic-assisted hysterectomy: a nationwide population-based study. Eur J Obstet Gynecol Reprod Biol 2012; 161:209-14. [PMID: 22300773 DOI: 10.1016/j.ejogrb.2011.12.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 11/21/2011] [Accepted: 12/21/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE With continuing development of minimally invasive techniques in gynecology, hysterectomy with laparoscopic assistance is increasingly performed. This study aimed to examine the relationship between the characteristics of gynecologists and the likelihood of performing laparoscopic-assisted hysterectomy (LH) under the case payment system of Taiwan's National Health Insurance. STUDY DESIGN A retrospective population-based study was conducted based on the data from Taiwan's National Health Insurance Research Database. A total of 56,532 female residents aged 20 years and older who underwent total hysterectomy with or without laparoscopic assistance between 2004 and 2006 were included in the study. The gender, age and practice volume of their gynecologists were noted. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by univariate and multivariate logistic regression analyses. RESULTS Of the women selected, 30,478 underwent traditional total hysterectomy (TH) and 26,054 underwent LH. After controlling for clinical and nonclinical factors, male gynecologists (OR 1.65, 95% CI 1.55-1.76) were more likely to perform LH than their female colleagues. Gynecologists aged 60 years and older (OR 0.31, 95% CI 0.29-0.39) had the lowest likelihood of performing LH compared with their counterparts. In addition, surgeons with low-volume practice (OR 0.31, 95% CI 0.29-0.33) also had a significantly lower probability of performing LH compared with other surgeons. CONCLUSION A higher likelihood of performing LH was observed among male and younger gynecologists with high-volume practice in Taiwan. This finding suggests that differences in practice patterns and surgical treatment decision may explain the variation in the approaches to laparoscopy-assisted hysterectomies. CONDENSATION Differences in practice patterns and surgical treatment decisions may explain the variation in the approaches to laparoscopic-assisted hysterectomies.
Collapse
Affiliation(s)
- Chun-Che Huang
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, 261 Wen-hwa 1st Road, Taipei, Taiwan
| | | | | |
Collapse
|
44
|
Changing trends of surgical approaches for uterine prolapse: an 11-year population-based nationwide descriptive study. Int Urogynecol J 2012; 23:865-72. [PMID: 22270728 DOI: 10.1007/s00192-011-1647-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 12/24/2011] [Indexed: 01/17/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The interest of uterus-preserving surgery has been growing. Based on a nationwide database, we examined surgical procedures for uterine prolapse in Taiwan during the study period of 1997-2007, a total of 11 years. METHODS The operations, either uterine suspension or hysterectomy, due to the diagnosis of uterine prolapse were indentified into the study. Data on several parameters were collected for analysis, i.e., the surgical type, patient factors (age and concomitant anti-incontinence surgery), surgeon factors (age and gender), and hospital factors (accreditation level and ownership). Data of this study were obtained from the inpatient expenditures by admission files of the National Health Insurance Research Database (NHIRD). The NHIRD was established by the National Health Research Institute with the aim of promoting research into current and emerging medical issues in Taiwan. RESULTS In total, 31,038 operations were identified for this study. There was a trend for increased use of uterine suspension with uterine preservation during the latter years, evidenced by joinpoint regression analyses. More women who were younger (<50 years) or had concomitant anti-incontinence surgery received uterine suspension. Younger surgeons (<50 years) and male surgeons tended to perform more uterine suspensions. As for hospital accreditation, more uterine suspension surgeries were performed in regional hospitals, followed by local hospitals and medical centers. As for hospital ownership, more uterine suspension surgeries were performed in private hospitals, followed by not-for-profit and government-owned hospitals. CONCLUSIONS There has been a considerable change in the surgical approach for uterine prolapse in Taiwan over the past 11 years. Patient age and concomitant anti-incontinence surgery, surgeon age and gender, and hospital accreditation and ownership may correlate with the choice of surgery for women with uterine prolapse.
Collapse
|
45
|
Trends in inpatient urinary incontinence surgery in the USA, 1998-2007. Int Urogynecol J 2011; 22:1437-43. [PMID: 21975533 DOI: 10.1007/s00192-011-1509-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 07/11/2011] [Indexed: 10/17/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study was conducted to assess national rates in stress urinary incontinence (SUI) surgery in the USA from 1998 to 2007. METHODS We utilized the 1998-2007 Nationwide Inpatient Sample and assessed women aged 20 years and older who underwent SUI surgery based on the International Classification of Diseases, 9th Revision (ICD-9) procedure and diagnosis codes. RESULTS The total number of SUI surgeries performed during this 10-year period was 759,821. The annual number of procedures increased from 37,953 in 1998 to 94,910 in 2007. The type of SUI surgery performed also changed (p < 0.001). In 1998, retropubic suspensions represented 52.3%, decreasing to 13.8% in 2007. "Other repair of SUI" (ICD-9 59.79) comprised 22.4% in 1998, increasing to 75.2% in 2007, likely representing midurethral slings. CONCLUSIONS The total number and incidence rates of SUI surgeries have increased from 1998 to 2007. The type of SUI surgery performed has also changed significantly, likely secondary to adoption of midurethral slings.
Collapse
|