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Tai TS, Tsai CF, Yang HY. Thyroid cancer risk in women after hysterectomy: A nationwide cohort study. Maturitas 2024; 185:107980. [PMID: 38555761 DOI: 10.1016/j.maturitas.2024.107980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/11/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVES Hysterectomy is commonly performed for benign uterine pathologies but there is some controversy over whether it is associated with an increased risk of thyroid cancer. This study examines the associations of hysterectomy with ovarian conservation or with bilateral salpingo-oophorectomy and thyroid cancer incidence in Taiwan. METHODS We analyzed data from a nationwide health insurance claims database and identified 29,577 women aged ≥30 years who underwent hysterectomy with ovarian conservation or hysterectomy with bilateral salpingo-oophorectomy between 2000 and 2016. Propensity score-matching analyses were performed at ratios of 1:1 for the hysterectomy and no-hysterectomy groups, to reduce selection bias. We monitored thyroid cancer occurrence in both groups until 2017. Cox regression was used to calculate hazard ratios with 95 % confidence intervals and determine thyroid cancer risk in women who underwent hysterectomy. RESULTS The study comprised 29,577 patients who underwent any hysterectomy and 29,577 participants who did not. The mean follow-up period was 10.03 ± 4.92 years. Patients who underwent hysterectomy had higher thyroid cancer incidence (4.72 per 10,000 person-years) than those who did not (3.06 per 10,000 person-years) and a greater risk of any thyroid cancer (adjusted hazard ratio = 1.40; 95 % confidence interval = 1.08-1.82). However, there was no association between hysterectomy with bilateral salpingo-oophorectomy and thyroid cancer incidence (p > 0.05). CONCLUSIONS Our findings suggest that women who undergo hysterectomy are at a higher risk of developing thyroid cancer than those who do not.
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Affiliation(s)
- Tsai-Sung Tai
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 60002, Taiwan
| | - Ching-Fang Tsai
- Clinical Data Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 60002, Taiwan
| | - Hsin-Yi Yang
- Clinical Data Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City 60002, Taiwan.
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Levonorgestrel intrauterine devices improve body constitution deviations in the perspective of traditional Chinese medicine and quality of life in patients with chronic pelvic pain and heavy menstrual bleeding. Taiwan J Obstet Gynecol 2022; 61:989-994. [DOI: 10.1016/j.tjog.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2021] [Indexed: 11/24/2022] Open
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Sallée C, Margueritte F, Marquet P, Piver P, Aubard Y, Lavoué V, Dion L, Gauthier T. Uterine Factor Infertility, a Systematic Review. J Clin Med 2022; 11:jcm11164907. [PMID: 36013146 PMCID: PMC9410422 DOI: 10.3390/jcm11164907] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022] Open
Abstract
Uterine factor infertility (UFI) is defined as a condition resulting from either a complete lack of a uterus or a non-functioning uterus due to many causes. The exact prevalence of UFI is currently unknown, while treatments to achieve pregnancy are very limited. To evaluate the prevalence of this condition within its different causes, we carried out a worldwide systematic review on UFI. We performed research on the prevalence of UFI and its various causes throughout the world, according to the PRISMA criteria. A total of 188 studies were included in qualitative synthesis. UFI accounted for 2.1 to 16.7% of the causes of female infertility. We tried to evaluate the proportion of the different causes of UFI: uterine agenesia, hysterectomies, uterine malformations, uterine irradiation, adenomyosis, synechiae and Asherman syndrome, uterine myomas and uterine polyps. However, the data available in countries and studies were highly heterogenous. This present systematic review underlines the lack of a consensual definition of UFI. A national register of patients with UFI based on a consensual definition of Absolute Uterine Factor Infertility and Non-Absolute Uterine Factor Infertility would be helpful for women, whose desire for pregnancy has reached a dead end.
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Affiliation(s)
- Camille Sallée
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, 87000 Limoges, France
- Correspondence: ; Tel.: +33-555-055-555
| | - François Margueritte
- Department of Gynecology and Obstetrics, Intercommunal Hospital Center of Poissy-Saint-Germain-en-Laye, 78103 Poissy, France
| | - Pierre Marquet
- Department of Pharmacology and Toxicology, Centre Hospitalier Universitaire de Limoges, 87042 Limoges, France
| | - Pascal Piver
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, 87000 Limoges, France
| | - Yves Aubard
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, 87000 Limoges, France
| | - Vincent Lavoué
- Department of Obstetrics and Gynecology, Hopital Universitaire de Rennes, 35000 Rennes, France
| | - Ludivine Dion
- Department of Obstetrics and Gynecology, Hopital Universitaire de Rennes, 35000 Rennes, France
| | - Tristan Gauthier
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, 87000 Limoges, France
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Wu CJ, Huang KJ, Chang WC, Li YX, Wei LH, Sheu BC. Analyzing the learning curve of vaginal pelvic reconstruction surgery with and without mesh by the cumulative summation test (CUSUM). Sci Rep 2022; 12:7025. [PMID: 35488055 PMCID: PMC9054794 DOI: 10.1038/s41598-022-11039-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 04/18/2022] [Indexed: 11/29/2022] Open
Abstract
Women who underwent vaginal pelvic reconstructive surgery with or without mesh consecutively between 2004 and 2018 were retrospectively analyzed to determine the learning curve in vaginal pelvic reconstructive surgery. With cumulative summation (CUSUM) analysis of surgical failure and operation time, we assessed the learning curve of vaginal pelvic reconstructive surgery, including sacrospinous ligament fixation, anterior colporrhaphy, posterior colporrhaphy, and optional vaginal hysterectomy with or without mesh placement. The study is based on two individual surgeons who performed vaginal pelvic reconstructive surgery with or without mesh. Two hundred and sixty-four women with stage III or IV pelvic organ prolapse underwent vaginal pelvic reconstructive surgery by surgeons A or B. The median follow-up time of 44 months ranged from 24 to 120 months. Surgical proficiency was achieved in 32–33 vaginal pelvic reconstructive surgery procedures without mesh and 37–47 procedures in the same surgery with mesh. The total surgical success rates for surgeons A and B were 82.2% and 94.1%, with median follow-up times of 60 and 33 months, respectively. More procedures were needed for the learning curve of vaginal pelvic reconstructive surgery with mesh. Having crossed the proficiency boundary, the surgical success rate and operation time were improved.
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Affiliation(s)
- Chin-Jui Wu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital , Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Kuan-Ju Huang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, College of Medicine, National Taiwan University, 15F, No. 8, Chung-Shan South Road, Taipei, 10002, Taiwan
| | - Wen-Chun Chang
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, College of Medicine, National Taiwan University, 15F, No. 8, Chung-Shan South Road, Taipei, 10002, Taiwan
| | - Ying-Xuan Li
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, College of Medicine, National Taiwan University, 15F, No. 8, Chung-Shan South Road, Taipei, 10002, Taiwan
| | - Lin-Hung Wei
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, College of Medicine, National Taiwan University, 15F, No. 8, Chung-Shan South Road, Taipei, 10002, Taiwan
| | - Bor-Ching Sheu
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, College of Medicine, National Taiwan University, 15F, No. 8, Chung-Shan South Road, Taipei, 10002, Taiwan.
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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] [Track Full Text] [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.
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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
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Lee M, Chung YJ, Kim HK, Hwang H, Park JY, Shin I, Kim C, Cho HH, Kim M, Jung CY, Chae KH, Kim S, Kim MR. Estimated Prevalence and Incidence of Uterine Leiomyoma, and Its Treatment Trend in South Korean Women for 12 years: A National Population-Based Study. J Womens Health (Larchmt) 2020; 30:1038-1046. [PMID: 32991229 DOI: 10.1089/jwh.2020.8398] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background: Although uterine leiomyoma causes many problems, including infertility, there are few studies that have investigated the epidemiologic characteristics of uterine leiomyoma in South Korea. The aim of this study is to estimate the prevalence and incidence of uterine leiomyoma in South Korea and analyze the treatment trends. Materials and Methods: Women of reproductive age (15-54 years) were selected from the Korean National Health Insurance Service (NHIS) sample cohort dataset, which was collected from 2002 to 2013. Patients with uterine leiomyoma were identified by ICD-10 (International Codes of Disease, 10th Edition) and intervention codes. Prevalence and incidence were calculated from the NHIS cohort dataset and the treatment trends were analyzed for diagnosed patients. Results: The prevalence in overall age groups increased from 0.96% in 2002 to 2.43% in 2013, and the 1-year incidences of all age groups increased. The 26-30 age group showed the highest rate of 1-year incidence increase (2.14-folds, 0.33% in 2003 to 0.70% in 2013). The proportion of myomectomy increased from 22% in 2002 to 49% in 2013, whereas the proportion of hysterectomy decreased from 78% to 45%. Conclusions: The prevalence and incidence of uterine leiomyoma are increasing in South Korea as time progresses, and the rate of incidence increase is higher in younger reproductive women. Overall trends in uterine leiomyoma treatment are shifting to the methods of the saving uterus.
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Affiliation(s)
- Minkyoung Lee
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Youn-Jee Chung
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun-Kyung Kim
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - HyeJin Hwang
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jee Yune Park
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Inhye Shin
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chaewon Kim
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun-Hee Cho
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mira Kim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chai Young Jung
- Biomedical Research Institute, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Kyung-Hee Chae
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sukil Kim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mee-Ran Kim
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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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.
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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).
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Risk of Hyperlipidemia in Women with Hysterectomy-A Retrospective Cohort Study in Taiwan. Sci Rep 2018; 8:12956. [PMID: 30154502 PMCID: PMC6113310 DOI: 10.1038/s41598-018-31347-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 08/17/2018] [Indexed: 12/17/2022] Open
Abstract
Hysterectomy has been associated with metabolic change and cardiovascular risk for women after removing the uterus, but inconclusive. This large retrospective cohort study evaluated the hyperlipidemia risk for women with a hysterectomy and/or oophorectomy. From claims data of one million people in the National Health Insurance (NHI) database of Taiwan, we established a cohort consisting of 5887 women newly received a surgery of hysterectomy from 2000-2013, 563 women had a hysterectomy and a oophorectomy, and 556 women had a oophorectomy. From the claims data, 28024 women without any of the surgeries were identified to form the comparison cohort, frequency matched by birth year and surgery year of the women with hysterectomy. By the end of 2013, the incidence of hyperlipidemia was 1.3 times greater in women with a hysterectomy than in comparison women (3.43 vs. 2.65 per 100 person-years), with an adjusted hazard ratio (aHR) of 1.27 (95% CI = 1.19-1.35) for hysterectomy women after controlling for age, oophorectomy, hormone therapy and comorbidities. The incidence of hyperlipidemia increased to 4.93 per 100 person-years in women with both a hysterectomy and an oophorectomy. The relative risk of hyperlipidemia was higher for young women than the elderly women with the surgery. Women with comorbidity of obesity, hypertension or diabetes had a higher incidence of hyperlipidemia. In conclusion, the risk of developing hyperlipidemia could be elevated for women who had a hysterectomy and/or an oophorectomy. Women with hysterectomy should routinely monitor their metabolic status, particularly for young women and those with comorbidity of metabolic symptoms.
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Ho YL, Li CS, Liu CC, Lin CC, Hung CJ, Kao CH. Disability benefits as an incentive for hysterectomy: Uterine fibroid patients in Taiwan. Women Health 2017; 58:866-883. [PMID: 28816634 DOI: 10.1080/03630242.2017.1358793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Worker compensation insurance in Taiwan ensures that a woman under the age of 45 years who has her uterus removed can receive disability compensation benefits. The present study investigated whether such a compensation policy was related to a woman's inclination to have a hysterectomy. We extracted the records of 16,030 women diagnosed with uterine fibroids (UF) between 2000 and 2010 from the Longitudinal Taiwan Health Insurance Database. Each younger and older age group had a significantly lower hysterectomy rate compared to that of the 44-year-old age group. Moreover, significantly more patients with lower monthly wages had had hysterectomies than those with higher monthly wages. Policy makers should be aware that worker compensation regulations in Taiwan might encourage women with economic need to undergo hysterectomy surgery when approaching the age of 45 years.
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Affiliation(s)
- Ya-Lee Ho
- a Department of Business Administration and Department of Business Administration , Feng Chia University , Taichung , Taiwan
| | - Chu-Shiu Li
- b Department of Risk Management and Insurance , National Kaohsiung First University of Science and Technology, Kaohsiung, and College of Management, Asia University , Taichung , Taiwan
| | - Chwen-Chi Liu
- c Department of Risk Management and Insurance , Feng Chia University , Taichung , Taiwan
| | - Che-Chen Lin
- d Management Office for Health Data , China Medical University Hospital , Taichung , Taiwan
| | - Chih-Jen Hung
- e Department of Anesthesiology, Taichung Veterans General Hospital, and Department of Nursing , Hung Kuang University , Taichung , Taiwan
| | - Chia-Hung Kao
- f Departments of Nuclear Medicine and PET Center, China-Medical University Hospital and Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine , China-Medical University , Taichung , Taiwan
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Nationwide trends and in-hospital complications of trachelectomy for surgically resectable cervical cancer in Taiwanese women: A population-based study, 1998–2013. Taiwan J Obstet Gynecol 2017; 56:449-455. [DOI: 10.1016/j.tjog.2016.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2016] [Indexed: 11/18/2022] Open
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11
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The characterization of trachelectomy for benign and precancerous indications in Taiwan: A population-based study, 1998–2013. Taiwan J Obstet Gynecol 2017; 56:495-501. [DOI: 10.1016/j.tjog.2016.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2016] [Indexed: 11/21/2022] Open
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12
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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.
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