Emad Mikhail1, Papri Sarkar1, Marilyn Moucharite2, Stuart Hart3. 1. Department of Obstetrics and Gynecology, University of South Florida/Morsani, College of Medicine, Tampa, Florida. 2. Healthcare Economics and Outcomes Research, Medtronic plc, Minneapolis, Minnesota. 3. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of South Florida/Morsani College of Medicine, Tampa, Florida Medical Director, Global Medical Affairs, Colorectal and Gynecologic Health, Surgical Innovations/Minimally Invasive Therapies Group, Medtronic plc, Minneapolis, Minnesota.
Abstract
BACKGROUND: There are large variations in the use of minimally invasive surgery (MIS), and outpatient hysterectomy (OP) among Medicare patients according to hospital surgical volume and geographical distribution. OBJECTIVE: To explore the changing trend in OP and MIS hysterectomy in the United States. STUDY DESIGN: We used all Medicare fee-for-service claims data for 2012 and 2014 to determine the incidence of OP and MIS hysterectomy according to hospital surgical volume and geographical distribution. MIS included both laparoscopy and robotic surgery. OP procedures included only same-day discharge hysterectomies. RESULTS: A total of 55,562 and 53,054 hysterectomies were performed in the years 2012 and 2014, respectively. OP rate in 2014 in high-volume centers (16,828 [47.1%]) exceeded low-volume centers (136 [16%]) by 31.1% (p<0.001). Time trends between 2014 and 2012 show that a rise in OP rate was 17.7% and 7% for high- and low-volume hospitals (p<0.001), respectively. High-volume hospitals showed an increase of 3.1% (p=0.003) in MIS hysterectomy rate in 2014 (69%) as compared to 2012 (65.9%). There was no change in MIS rate among low-volume hospitals. CONCLUSION: In the Medicare population, the rate of OP and MIS hysterectomy for high-volume centers is significantly different form low-volume centers. Over the years, outpatient hysterectomy is being practiced widely but an increase in MIS rate is limited to high-volume centers.
BACKGROUND: There are large variations in the use of minimally invasive surgery (MIS), and outpatient hysterectomy (OP) among Medicare patients according to hospital surgical volume and geographical distribution. OBJECTIVE: To explore the changing trend in OP and MIS hysterectomy in the United States. STUDY DESIGN: We used all Medicare fee-for-service claims data for 2012 and 2014 to determine the incidence of OP and MIS hysterectomy according to hospital surgical volume and geographical distribution. MIS included both laparoscopy and robotic surgery. OP procedures included only same-day discharge hysterectomies. RESULTS: A total of 55,562 and 53,054 hysterectomies were performed in the years 2012 and 2014, respectively. OP rate in 2014 in high-volume centers (16,828 [47.1%]) exceeded low-volume centers (136 [16%]) by 31.1% (p<0.001). Time trends between 2014 and 2012 show that a rise in OP rate was 17.7% and 7% for high- and low-volume hospitals (p<0.001), respectively. High-volume hospitals showed an increase of 3.1% (p=0.003) in MIS hysterectomy rate in 2014 (69%) as compared to 2012 (65.9%). There was no change in MIS rate among low-volume hospitals. CONCLUSION: In the Medicare population, the rate of OP and MIS hysterectomy for high-volume centers is significantly different form low-volume centers. Over the years, outpatient hysterectomy is being practiced widely but an increase in MIS rate is limited to high-volume centers.
Authors: Annmarie L Vilkins; Michael Sahara; Sara R Till; Christina Ceci; Ryan Howard; Kendall C Griffith; Jennifer F Waljee; Courtney S Lim; Bethany D Skinner; Daniel J Clauw; Chad M Brummett; Sawsan As-Sanie Journal: Obstet Gynecol Date: 2019-10 Impact factor: 7.661