Hysterectomy in Poland between 2011 and 2016. Changing trends in the surgical approach to hysterectomy

Abstract

Objectives: In Poland, approximately 35,000 women a year undergo hysterectomy. The surgical approach may vary depending on the indications and experience of the operator and advances in laparoscopic surgical techniques. The aim of the present study was to analyze trends in the use of various types of hysterectomy in Poland between 2011 and 2016. Summary values were given as numbers and percentages. Annual incidence of procedures and identify factors which influence these changes in gynecological practice. Material and methods: Data on hysterectomy procedures performed between 2011 and 2016 in Poland acquired from the National Health Fund reports were extracted and analyzed. Summary values were given as numbers, percentages and rate ratios (RR). Annual incidence of procedures and identify factors that influence these changes in gynecological practice. Results: Between 2011 and 2016, 215,744 women were treated by hysterectomy in inpatient settings. The total number of those procedures in analyzed period decreased by 11.5%; the incidence rate dropped by 2.15 per 100,000 women. A significant increase in laparoscopic procedures was observed (RR = 3.85; CI: 3.57-4.16; p < 0.001) along with a decrease in the number of abdominal operations (RR = 0.82; CI: 0.81-0.83; p < 0.001). Conclusions: Surgical technique advances, introduction of intrauterine systems and hormonal therapy, as well as recommendations of international institutions have brought about changes in the methods and frequency of hysterectomy. The laparoscopic approach has been gaining popularity since it is beneficial both for patients and public health system. However, the percentage of advanced minimally invasive hysterectomies is still low in Poland in comparison to other countries.

Trends in surgical approaches and adnexal surgeries during hysterectomies for benign diseases between 2015–2021

“…Meanwhile, the slight increase in BSO was inconsistent with the findings reported by Lai et al ( 14 ), which presented a decreasing trend in this surgery . As for the number of hysterectomies with/without adnexal surgeries in each surgical method, a significant reduction in the number of AH by −17.89% accompanied by an increase in the number of TLH by 36.56% over the study period suggests a positive change in our hospital, which was consistent with the Polish study ( 15 ). There was also a sharp downward trend in the total number of hysterectomies between 2019 and 2020.…”

Prevention of complications of surgical treatment of stage III-IV cystocele using light polypropylene mesh

“…The total vaginal length increased from 8.2 ± 2.1 to 10.2 ± 1.7 cm after the surgery, the Ba point changed from +4.6 ± 2.7 to −1.8 ± 1.7, the Bp point changed from +0.7 ± 2.3 to −1.6 ± 1.2 cm 12 months after treatment. Similar positive results from the anatomical structures reconstruction in the case of pelvic organ prolapse using polypropylene mesh were presented in the study of Delroy et al, 12 the anatomical success rate was 82.5% 1 year after surgery. The Ba point changed from +2.8 to −1.9 cm after the surgery, the Bp indicator was 3.0 cm before the surgery and 3.5 cm after it.…”

“…Only nine studies completely describe the results of surgical treatment of cystocele using different TVM types. [11][12][13][14][15][16][17][18][19] A review of 16 studies in the Cochrane database showed a high percentage of specific complications in the form of erosion of the vaginal wall. However, these studies did not report a vaginal wall recovery method that could show any significant difference in terms of risk of re-surgery or unsatisfactory functional and anatomical aspects, especially because the use of TVM itself is connected with the risk of specific complications (shrinking, exposure, pain, dyspareunia).…”

“…10 The number of specific complications during the performance of a certain surgery type using TVM in vaginal surgery and their impact on the quality of women's life, has not been thoroughly studied until now. [11][12][13][14][15][16][17][18][19] In 2016, the scientific community reported 21 cases of repeated interventions due to the development of complications after TVM surgery in the anterior area (Prolift, Perigee and Avaulta). Indications for re-intervention were erosions, pain, including dyspareunia, apareunia, relapse of prolapse.…”

Appropriateness of hysterectomies at the time of surgical removal of presumed benign adnexal masses

“…Hysterectomy rates have witnessed a worldwide decrease as the result of advances in minimally invasive uterus-sparing procedures. [1][2][3] However, this procedure continues to be the second most common surgery performed in the USA, with over 600 000 women undergoing a hysterectomy annually. 4 Several studies looked at the appropriateness of hysterectomy and potential overuse.…”