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Hysterectomy Practice Patterns in the Postmorcellation Era

Jorgensen, Elisa M. MD; Modest, Anna M. PhD, MPH; Hur, Hye-Chun MD MPH; Hacker, Michele R. ScD, MSPH; Awtrey, Christopher S. MD

doi: 10.1097/AOG.0000000000003181
Contents: Gynecologic Surgery: Original Research
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OBJECTIVE: To characterize long-term national trends in surgical approach for hysterectomy after the U.S. Food and Drug Administration (FDA) warning against power morcellation for laparoscopic specimen removal.

METHODS: This was a descriptive study using data from the American College of Surgeons National Surgical Quality Improvement Program from 2012 to 2016. We identified hysterectomies using Current Procedural Terminology codes. We used an interrupted time-series analysis to evaluate abdominal and supracervical hysterectomy trends surrounding The Wall Street Journal article first reporting morcellation safety concerns and the FDA safety communication. We compared categorical and continuous variables using χ2, t, and Wilcoxon rank sum tests.

RESULTS: We identified 179,950 hysterectomies; laparoscopy was the most common mode of hysterectomy in every quarter. Before The Wall Street Journal article, there was no significant change in proportion of abdominal hysterectomies (0.3% decrease/quarter, P=.14). After The Wall Street Journal article, use of abdominal hysterectomy increased 1.1% per quarter for two quarters through the FDA warning (P<.001), plateaued for three quarters until March 2015 (P=.65), then decreased by 0.8% per quarter through 2016 (P<.001). Supracervical hysterectomy volume continuously decreased after the FDA warning (1.0% decrease per quarter, P<.001) and after three quarters (0.7% decrease per quarter, P=.01), then plateaued from April 2015 through 2016 (0.05% decrease per quarter, P=.40). Mode of supracervical hysterectomy was unchanged from 2012 to 2013 (P=.43), followed by two quarters of significant increase in proportion of supracervical abdominal hysterectomies (11.7%/quarter, P<.001). This change in mode of supracervical hysterectomy then plateaued through 2016 (P=.06).

CONCLUSION: Despite early studies suggesting that minimally invasive hysterectomy decreased in response to safety concerns regarding power morcellation, we found that this effect reversed 1 year after the FDA safety communication. However, there was a sustained decline in supracervical hysterectomy, and the remaining supracervical hysterectomies were more likely to be performed using laparotomy.

Despite early findings of decreased rates of minimally invasive hysterectomy after power morcellation safety warnings, this trend has reversed since March 2015.

Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.

Corresponding author: Christopher S. Awtrey, MD, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Kirstein 3, Boston, MA 02215; email: cawtrey@bidmc.harvard.edu.

Financial Disclosure Michele R. Hacker received money paid to her institution from the Breast Cancer Research Foundation, Society for Family Planning, and the Charles Koch Foundation. She has also received funds from the NIH and Affiliates Risk Management Services, Inc. The other authors did not report any potential conflicts of interest.

Presented at the 47th AAGL Global Congress, November 11–15, 2018, Las Vegas, Nevada.

This work was conducted with support from Harvard Catalyst, Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR001102) and financial contributions from Harvard University and its affiliated academic health care centers.

Peer reviews and author correspondence are available at http://links.lww.com/AOG/B319.

Each author has confirmed compliance with the journal's requirements for authorship.

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.