PMID- 28486359
OWN - NLM
STAT- MEDLINE
DCOM- 20170714
LR  - 20180714
IS  - 1873-233X (Electronic)
IS  - 0029-7844 (Linking)
VI  - 129
IP  - 6
DP  - 2017 Jun
TI  - Minimally Invasive Hysterectomy and Power Morcellation Trends in a West Coast
      Integrated Health System.
PG  - 996-1005
LID - 10.1097/AOG.0000000000002034 [doi]
AB  - OBJECTIVE: To examine trends in minimally invasive hysterectomy and power
      morcellation use over time and associated clinical characteristics. METHODS: We
      conducted a trend analysis and retrospective cohort study of all women 18 years
      of age and older undergoing hysterectomy for benign conditions at Kaiser
      Permanente Northern California collected from electronic health records.
      Generalized estimating equations and Cochran-Armitage testing were used to assess
      the primary outcomes, hysterectomy incidence, and proportion of hysterectomies by
      surgical route and power morcellation. Logistic regression analysis was used to
      assess secondary outcomes, clinical characteristics, and complications associated
      with surgical route. RESULTS: There were 31,971 hysterectomies from 2008 to 2015;
      the incidence decreased slightly from 2.86 (95% confidence interval [CI]
      2.85-2.87) to 2.60 (95% CI 2.59-2.61) per 1,000 women (P<.001). Minimally
      invasive hysterectomies increased from 39.8% to 93.1%, almost replacing abdominal
      hysterectomies entirely (P<.001). Vaginal hysterectomies decreased slightly from 
      26.6% to 23.4% (P<.001). The proportion of nonrobotic laparoscopic hysterectomies
      with power morcellation increased steadily from 3.7% in 2008 to a peak of 11.4%
      in 2013 and decreased to 0.02% in 2015 (P<.001). Robot-assisted laparoscopic
      hysterectomies remained a small proportion of all hysterectomies comprising 7.8% 
      of hysterectomies in 2015. Women with large uteri (greater than 1,000 g) were
      more likely to receive abdominal hysterectomies than minimally invasive
      hysterectomy (adjusted relative risk 11.62, 95% CI 9.89-13.66) and laparoscopic
      hysterectomy with power morcellation than without power morcellation (adjusted
      relative risk 5.74, 95% CI 4.12-8.00). Laparoscopic supracervical hysterectomy
      was strongly associated with power morcellation use (adjusted relative risk
      43.89, 95% CI 37.55-51.31). CONCLUSION: A high minimally invasive hysterectomy
      rate is primarily associated with uterine size and can be maintained without
      power morcellation.
FAU - Zaritsky, Eve
AU  - Zaritsky E
AD  - Department of Obstetrics and Gynecology, the Permanente Medical Group, Oakland,
      Roseville, and Richmond, and the Division of Research and Regional Women's
      Health, Kaiser Permanente Northern California, Oakland, California.
FAU - Tucker, Lue-Yen
AU  - Tucker LY
FAU - Neugebauer, Romain
AU  - Neugebauer R
FAU - Chou, Tatiana
AU  - Chou T
FAU - Flanagan, Tracy
AU  - Flanagan T
FAU - Walter, Andrew J
AU  - Walter AJ
FAU - Raine-Bennett, Tina
AU  - Raine-Bennett T
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Obstet Gynecol
JT  - Obstetrics and gynecology
JID - 0401101
SB  - AIM
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - California/epidemiology
MH  - Cohort Studies
MH  - Female
MH  - Humans
MH  - Hysterectomy/*utilization
MH  - Insurance Claim Review
MH  - Medical Records
MH  - Middle Aged
MH  - Minimally Invasive Surgical Procedures/utilization
MH  - Morcellation/adverse effects/*utilization
MH  - Postoperative Complications
MH  - Practice Patterns, Physicians'/*trends
MH  - Regression Analysis
MH  - Retrospective Studies
MH  - Uterine Diseases/*surgery
MH  - Young Adult
EDAT- 2017/05/10 06:00
MHDA- 2017/07/15 06:00
CRDT- 2017/05/10 06:00
PHST- 2017/05/10 06:00 [pubmed]
PHST- 2017/07/15 06:00 [medline]
PHST- 2017/05/10 06:00 [entrez]
AID - 10.1097/AOG.0000000000002034 [doi]
PST - ppublish
SO  - Obstet Gynecol. 2017 Jun;129(6):996-1005. doi: 10.1097/AOG.0000000000002034.