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Hysterectomy Practice Patterns in the Postmorcellation Era.

Elisa M Jorgensen1, Anna M Modest, Hye-Chun Hur

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Obstetrics and Gynecology
|March 15, 2019
PubMed
Summary
This summary is machine-generated.

Hysterectomy surgical approaches shifted after FDA warnings on power morcellation. Abdominal hysterectomy initially increased, then decreased, while supracervical hysterectomy declined, with more cases performed via laparotomy.

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Area of Science:

  • Gynecology
  • Surgical Oncology
  • Public Health

Background:

  • The U.S. Food and Drug Administration (FDA) issued a safety communication regarding power morcellation for laparoscopic hysterectomy specimen removal.
  • Concerns about potential spread of undiagnosed cancer influenced surgical approach trends.

Purpose of the Study:

  • To analyze national trends in hysterectomy surgical approaches following the FDA warning on power morcellation.
  • To evaluate changes in abdominal and supracervical hysterectomy rates and methods.

Main Methods:

  • Descriptive study using data from the American College of Surgeons National Surgical Quality Improvement Program (2012-2016).
  • Interrupted time-series analysis to assess trends around key safety communication dates.
  • Comparison of hysterectomy types (abdominal, laparoscopic, supracervical) and surgical approaches.

Main Results:

  • Laparoscopy remained the most common hysterectomy approach.
  • Abdominal hysterectomy use increased initially after a media report and FDA warning, then decreased.
  • Supracervical hysterectomy volume consistently declined, with a shift towards laparotomy for remaining cases.

Conclusions:

  • The initial decrease in minimally invasive hysterectomy following morcellation concerns reversed post-FDA communication.
  • A sustained decline in supracervical hysterectomy was observed, with a trend towards open laparotomy.