Abstract: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.
“…Similar exclusion criteria were applied for establishing the comparison group, which was randomly selected from women without the history of hysterectomy and oophorectomy, with a sample size 4-fold of the case group, frequency matched by the year of birth and the year of surgery. The validity of hysterectomy and hyperlipidemia in the claims data of NHIRD has been reported in previous reports 5 – 7 . Figure 1 The flow chart for identifying study cohorts from the National Health Insurance Research Database.…”
Section: Methodssupporting
confidence: 55%
“…We established a hysterectomy related case group, including women who had received only a hysterectomy, both a hysterectomy and an oophorectomy, and only an oophorectomy from 2000 to 2013. Cases were defined by the procedure codes of 65.5, 65.6, 68.3–5, 68.9 7 and diagnoses codes of uterine myoma (ICD9 code: 218.9), adenomyosis (ICD9 code: 617.0), uterine prolapse (ICD9 code: 618), and ovarian tumor ICD9 code: 220. Women who had been diagnosed with hyperlipidemia (ICD9 code: 272) and/or cancer at baseline, or with cancer within 1 year after hysterectomy were excluded (Fig.…”
Section: Methodsmentioning
confidence: 99%
“…Hysterectomy is a surgery to remove the uterus, which is one of common gynecologic surgeries for women in both developed and developing areas 5 , 6 . Hysterectomy is generally recommended for benign clinical indications, such as uterine leiomyoma, abnormal uterine bleeding and endometriosis, in addition to for reproductive cancers 7 . It has been a concern for the potential of leading to hormone changes after hysterectomy and increasing the risk of CVD and other comorbidities 8 – 10 .…”
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.
“…Similar exclusion criteria were applied for establishing the comparison group, which was randomly selected from women without the history of hysterectomy and oophorectomy, with a sample size 4-fold of the case group, frequency matched by the year of birth and the year of surgery. The validity of hysterectomy and hyperlipidemia in the claims data of NHIRD has been reported in previous reports 5 – 7 . Figure 1 The flow chart for identifying study cohorts from the National Health Insurance Research Database.…”
Section: Methodssupporting
confidence: 55%
“…We established a hysterectomy related case group, including women who had received only a hysterectomy, both a hysterectomy and an oophorectomy, and only an oophorectomy from 2000 to 2013. Cases were defined by the procedure codes of 65.5, 65.6, 68.3–5, 68.9 7 and diagnoses codes of uterine myoma (ICD9 code: 218.9), adenomyosis (ICD9 code: 617.0), uterine prolapse (ICD9 code: 618), and ovarian tumor ICD9 code: 220. Women who had been diagnosed with hyperlipidemia (ICD9 code: 272) and/or cancer at baseline, or with cancer within 1 year after hysterectomy were excluded (Fig.…”
Section: Methodsmentioning
confidence: 99%
“…Hysterectomy is a surgery to remove the uterus, which is one of common gynecologic surgeries for women in both developed and developing areas 5 , 6 . Hysterectomy is generally recommended for benign clinical indications, such as uterine leiomyoma, abnormal uterine bleeding and endometriosis, in addition to for reproductive cancers 7 . It has been a concern for the potential of leading to hormone changes after hysterectomy and increasing the risk of CVD and other comorbidities 8 – 10 .…”
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.
“…LHs have increased worldwide because of less postoperative pain, shorter hospital length of stay, and faster recovery [3]. Previous studies in the United States [1], Austria [4], the Netherlands [5], Italy [6], and Taiwan [2,7,8] showed an increase in laparoscopic techniques and a decrease in total abdominal hysterectomy (TAH) and VH. Huang et al [7] reported an increase in subtotal abdominal hysterectomy (SAH).…”
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.
“…Logically, the CUSUM learning curve analysis of in-hospital complication rates would nd fewer procedures required than analysis of surgical recurrence found and more procedures than operation time did. The other limitation is that hysterectomy volumes fell in Taiwan during our follow-up period 23 . This caused a signi cant difference in the rates of previous and concurrent hysterectomy in surgeon A's cohort.…”
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. Two hundred and sixty-four women with stage III or IV pelvic organ prolapse underwent vaginal pelvic reconstructive surgery by surgeon A or B. The median follow-up time of 44 months ranged from 24 to 120 months. Surgical proficiency was achieved in 32-54 vaginal pelvic reconstructive surgery procedures without mesh and 37-61 procedures in the same surgery with mesh. The 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. The learning phase of vaginal pelvic reconstructive surgery in advanced pelvic organ prolapse in this institutional cohort required 54 and 61 procedures, respectively. A higher number of procedures were required for the learning curve of vaginal pelvic reconstructive surgery with mesh. Having crossed the boundary of proficiency, the surgical success rate and operation time were improved.
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