Reduced Complications Following Implementation of Laparoscopic Hysterectomy: A Danish Population-based Cohort Study of Minimally Invasive Benign Gynecologic Surgery between 2004 and 2018

Settnes, Annette; Topsoee, Märta Fink; Moeller, Charlotte; Dueholm, Margit; Kopp, Tine Iskov; Norrbom, Christina; Rasmussen, Steen; Froeslev, Pia Arnum; Joergensen, Annemette; Dreisler, Eva; Gimbel, Helga

doi:10.1016/j.jmig.2019.11.005

Cited by 16 publications

(19 citation statements)

References 31 publications

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“…While a moderate decrease in overall hysterectomy rates by 16% [1] was observed in Switzerland between 2002 and 2016 (6% from 2013 to 2016), the rates decreased by more than 30% in France and the USA [33] and by more than 50% in Finland during the same time period [1]. Our data demonstrate that vaginal and abdominal hysterectomy is increasingly replaced by laparoscopic hysterectomy, a phenomenon that has also been observed in other countries [7,[34][35][36][37]. While the decrease in invasive abdominal procedures may be desirable due to fewer complications [7], the substitution of vaginal hysterectomies by laparoscopic procedures is not in agreement with guideline recommendations [3][4][5]11].…”

Section: Discussionsupporting

confidence: 72%

“…Our data demonstrate that vaginal and abdominal hysterectomy is increasingly replaced by laparoscopic hysterectomy, a phenomenon that has also been observed in other countries [7,[34][35][36][37]. While the decrease in invasive abdominal procedures may be desirable due to fewer complications [7], the substitution of vaginal hysterectomies by laparoscopic procedures is not in agreement with guideline recommendations [3][4][5]11]. Compared to vaginal hysterectomy, Abbreviations: CI = confidence interval; SSEP = Swiss neighborhood index of socioeconomic position.…”

Section: Discussionmentioning

confidence: 63%

“…For example, in women with endometriosis, hysterectomy is not recommended unless pharmacological and minimally invasive treatment strategies fail to control symptoms and after family planning is completed [3][4][5]. Although the procedure is considered to be safe, complications may occur including infections (9-13%), venous thromboembolism (1-12%), and genitourinary and gastrointestinal tract injuries (1-2%) [6] depending on the specific procedure performed [7]. Moreover, guidelines recommend vaginal hysterectomy as the first choice due to fewer intraand postoperative complications [8,9], shorter operation and hospitalization times [5,10,11], and lower healthcare costs [10].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, guidelines recommend vaginal hysterectomy as the first choice due to fewer intraand postoperative complications [8,9], shorter operation and hospitalization times [5,10,11], and lower healthcare costs [10]. When vaginal hysterectomy is not possible, the less invasive laparoscopic hysterectomy is preferable over the more invasive abdominal hysterectomy [3,11], due to fewer complications [7]. Abdominal hysterectomy is recommended for extrauterine disease, and when uterus size precludes other procedures [3,5,11].…”

Section: Introductionmentioning

confidence: 99%

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Regional variation of hysterectomy for benign uterine diseases in Switzerland

et al. 2020

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Background Hysterectomy is the last treatment option for benign uterine diseases, and vaginal hysterectomy is preferred over more invasive techniques. We assessed the regional variation in hysterectomy rates for benign uterine diseases across Switzerland and explored potential determinants of variation. Methods We conducted a population-based analysis using patient discharge data from all Swiss hospitals between 2013 and 2016. Hospital service areas (HSAs) for hysterectomies were derived by analyzing patient flows. We calculated age-standardized mean procedure rates and measures of regional variation (extremal quotient [EQ], highest divided by lowest rate) and systematic component of variation [SCV]). We estimated the reduction in the variance of crude hysterectomy rates across HSAs in multilevel regression models, with incremental adjustment for procedure year, age, cultural/socioeconomic factors, burden of disease, and density of gynecologists. Results Overall, 40,211 hysterectomies from 54 HSAs were analyzed. The mean age-standardized hysterectomy rate was 298/100,000 women (range 186-456). While the variation in overall procedure rate was moderate (EQ 2.5, SCV 3.7), we found a very high procedure-specific variation (EQ vaginal 5.0, laparoscopic 6.3, abdominal 8.0; SCV vaginal 17.5, laparoscopic 11.2, abdominal 16.9). Adjusted for procedure year, demographic, cultural, and sociodemographic factors, a large share (64%) of the variance remained unexplained (vaginal 63%, laparoscopic 85%, abdominal 70%). The main determinants of variation were socioeconomic/cultural factors. Burden of disease and the density of gynecologists was not associated with procedure rates.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Regional variation of hysterectomy for benign uterine diseases in Switzerland

et al. 2020

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“… 2 , 12 , 13 , 21 , 25 Our findings of a temporal decline in hysterectomy incidence rates are consistent with previous US, Australian, and European studies. 5 , 12 , 13 , 25 , 26 However, most of the previous studies reported incidence rates of hysterectomy without correction for previous hysterectomy. Furthermore, the study populations differ by age of women included and by indication for hysterectomy, with most studies reporting incidence rates of benign hysterectomy.…”

Section: Discussionmentioning

confidence: 99%

Trends in Hysterectomy Incidence Rates During 2000–2015 in Denmark: Shifting from Abdominal to Minimally Invasive Surgical Procedures

Lycke¹,

Kahlert²,

Damgaard³

et al. 2021

CLEP

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Background Hysterectomy (removal of the uterus) is a common surgical procedure in gynecology. Although minimally invasive surgical procedures have been introduced, hysterectomy is still associated with risk of short- and long-term complications. Given that hysterectomized women are no longer at risk of either hysterectomy or being diagnosed with endometrial or cervical cancer, it is important to describe trends in hysterectomy rates. Objective To describe trends in hysterectomy incidence rates overall and stratified by age, indication, and procedure. Methods Nationwide population-based cohort study using Danish national registries, 2000–2015, was conducted. We calculated the overall hysterectomy-corrected and age-standardized incidence rates of hysterectomy among women ≥20 years old. Incidence rates were stratified by age group, indication, and surgical procedure. We performed trend analyses using Joinpoint regression, thereby estimating the average annual percentage change (AAPC). Results A total of 98,484 women had a hysterectomy during the study period, corresponding to an overall age-standardized, hysterectomy-corrected hysterectomy incidence rate (SIR) of 351.1 per 100,000 person-years (95% CI 348.9;353.3). SIR of hysterectomy declined over time (AAPC −1.4; 95% CI −1.9;-1.0), which was driven by a decline in rates of benign hysterectomy (AAPC −2.1; 95% CI −2.7;-1.6). Irrespective of indication, rates of abdominal hysterectomy declined substantially during the study period and were surpassed by rates of minimally invasive procedures (ie, laparoscopy and robot-assisted laparoscopy) in 2013. Conclusion Hysterectomy-corrected incidence rates of benign hysterectomy declined over time. Irrespective of indication, we observed a shift in surgical procedure over time, from abdominal hysterectomy to minimally invasive surgical procedures.

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Abdominal hysterectomy and high frailty score are associated with complications among older patients

Wainger

Yazdy

Handa

2021

Intl J Gynecology & Obste

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As the US population of older adults increases, the number of older hysterectomy patients will increase. 1 Evidence demonstrates a wide range of postoperative outcomes in older adults of the same chronologic age. Consequently, frailty has been examined as a way to better predict which older patients have higher risk for poor surgical outcomes. 2 Frailty has been conceptualized as an "age-related, multidimensional state of decreased physiologic reserves that results in diminished resiliency, loss of adaptive capacity, and increased vulnerability to stressors". 3 From a practical perspective, frailty has

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Reduced Complications Following Implementation of Laparoscopic Hysterectomy: A Danish Population-based Cohort Study of Minimally Invasive Benign Gynecologic Surgery between 2004 and 2018

Cited by 16 publications

References 31 publications

Regional variation of hysterectomy for benign uterine diseases in Switzerland

Regional variation of hysterectomy for benign uterine diseases in Switzerland

Trends in Hysterectomy Incidence Rates During 2000–2015 in Denmark: Shifting from Abdominal to Minimally Invasive Surgical Procedures

Abdominal hysterectomy and high frailty score are associated with complications among older patients

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