Epidemiological analysis of hysterectomies performed at the public health system in the largest Brazilian city

Abstract

OBJECTIVE:To analyze the public data of hysterectomies performed in the only health system in the city of São Paulo between 2008 and 2018. METHODS:The following public health system data were extracted and analyzed: age, technique, number of surgeries, mortality during hospitalization, length of stay in the establishment (days), and amounts paid by the public network.RESULTS: A total of 20,119 procedures were analyzed. The most prevalent procedure was total hysterectomy (43.2%), followed by vaginal hysterectomy (26.7%), subtotal hysterectomy (24.3%), and laparoscopic hysterectomy (5.8%). Early discharge (hospital stay of up to 1 day) was more prevalent in cases of vaginal hysterectomy (39%). We observed a marked downward trend in the number of total hysterectomies. Total hysterectomy was the most expensive procedure; no significant difference was noted in the cost of vaginal versus laparoscopic hysterectomy. We noticed a trend of rising costs over the years. The most frequent hospital admission code was that of leiomyoma of the uterus in cases of total, subtotal, and laparoscopic hysterectomy. CONCLUSION: Despite the decrease in the number of hysterectomies over the 11-year study period in São Paulo, it remains in high demand mainly for the treatment of uterine leiomyomatosis. Laparoscopic hysterectomy has been gaining ground and showed a slightly upward trend with a shorter hospital stay. Laparoscopic and vaginal hysterectomy required less financial support from the health system than open surgery.

An age-period-cohort analysis of hysterectomy incidence trends in Germany from 2005 to 2019

“…The earlier peak for total and subtotal hysterectomy at 45–49 years found in our study, is consistent with that of estimates in the United States 43 , Denmark 23 and Brazil 36 . In a cross-sectional analysis of women who had undergone a hysterectomy in the city of Mainz and the Mainz-Bingen region in Germany, the probability of having a hysterectomy was highest in the 45–49-year age group 44 .…”

“…In 2014, the Food and Drug Administration warned against the risk of inadvertent spread of occult malignancy with the use of morcellators with the laparoscopic subtotal hysterectomy procedure 33 , which subsequently led to a 50% reduction in the procedure in the US 34 . Decreased conduct of the procedure has been reported in countries like Finland 35 and Brazil 36 . In Germany, guidelines by the German Society of Obstetricians and Gynaecologists did not limit the use of this approach but recommended an investigative workup to exclude malignancy before the procedure 8 .…”

Short‐term outcomes after an enhanced recovery after surgery protocol in abdominal hysterectomies for leiomyomas in a teaching hospital

“…1 In Brazil, 1 275 501 hysterectomies were performed between 2008 and 2021 with a mean hospitalization time of 3-5 days, 634 deaths from the procedure, and a mortality rate of five cases per 10 000 surgeries. 2,3 A significant number of perioperative complications with rates of prolonged hospitalizations related to inadequate perioperative care has been observed. 2 To reduce the length of hospital stay without compromising patient safety, clinical and organizational actions that improve perioperative outcomes and lead to faster recovery are recommended by the enhanced recovery after surgery (ERAS) protocol.…”

“…Hysterectomy is the most frequently performed gynecological surgery and is indicated for pelvic pain and abnormal uterine bleeding caused by leiomyomas, adenomyosis, precancerous and cancerous lesions, and postpartum hemorrhage 1 . In Brazil, 1 275 501 hysterectomies were performed between 2008 and 2021 with a mean hospitalization time of 3–5 days, 634 deaths from the procedure, and a mortality rate of five cases per 10 000 surgeries 2,3 …”