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Trends in surgical approach to hysterectomy and perioperative outcomes in Michigan hospitals from 2010 through 2020

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Abstract

The objective of this study was to determine the trends in surgical approach to hysterectomy over the last decade and compare perioperative outcomes and complications. This retrospective cohort study used clinical registry data from the Michigan Hospitals that participated in Michigan Surgical Quality Collaborative (MSQC) from January 1st, 2010 through December 30th, 2020. A multigroup time series analysis was performed to determine how surgical approach to hysterectomy [open/TAH, laparoscopic (TLH/LAVH), and robotic-assisted (RA)] has changed over the last decade. Abnormal uterine bleeding, uterine fibroids, chronic pelvic pain, pelvic organ prolapse, endometriosis, pelvic mass, and endometrial cancer were the most common indications for hysterectomy. The open approach to hysterectomy declined from 32.6 to 16.9%, a 1.9-fold decrease, with an average decline of 1.6% per year (95% CI − 2.3 to − 0.9%). Laparoscopic-assisted hysterectomies decreased from 27.2 to 23.8%, a 1.5-fold decrease, with an average decrease of 0.1% per year (95% CI − 0.7 to 0.6%). Finally, the robotic-assisted approach increased from 38.3 to 49.3%, a 1.25-fold increase, with an average of 1.1% per year (95% CI 0.5 to 1.7%). For malignant cases, open procedures decreased from 71.4 to 26.6%, a 2.7-fold decrease, while RA-hysterectomy increased from 19.0 to 58.7%, a 3.1-fold increase. After controlling for the confounding variables age, race, and gynecologic malignancy, RA hysterectomy was found to have the lowest rate of complications when compared to the vaginal, laparoscopic and open approaches. Finally, after controlling for uterine weight, black patients were twice as likely to undergo an open hysterectomy compared to white patients.

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Acknowledgements

The authors of this manuscript would like to thank the wonderful staff at the Michigan Surgical Quality Collaborative (MSQC), especially Heather Marshall, Kushal Singh, and Alexander Hallway for their help retrieving data and their guidance in the production of this manuscript.

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Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Ascension St. John Hospital, 22101 Moross Rd, Detroit, MI, 48236, USA

    Michael G. Baracy Jr.

  2. Department of Family Medicine, Ascension St. John Hospital, Detroit, MI, 48236, USA

    Alexis Kerl

  3. Department of Biomedical Investigations and Research, Ascension St. John Hospital, Detroit, MI, 48236, USA

    Karen Hagglund

  4. Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, 48202, USA

    Brian Fennell

  5. Department of Gynecologic Oncology, Wayne State University, Detroit, MI, 48202, USA

    Logan Corey

  6. Department of Female Pelvic Medicine and Reconstructive Surgery, Ascension St. John Hospital, Detroit, MI, 48236, USA

    Muhammad Faisal Aslam

  7. College of Osteopathic Medicine, Michigan State University, East Lansing, MI, 48824, USA

    Muhammad Faisal Aslam

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  1. Michael G. Baracy Jr.
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  2. Alexis Kerl
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  3. Karen Hagglund
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  4. Brian Fennell
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  5. Logan Corey
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Contributions

MB conceived of the idea, designed the protocol and wrote the manuscript. MB, AK, and BF organized operative diagnoses, CPT codes, ICD-9 and ICD-10 codes and ensured integrity of codification. KH verified the protocol was methodologically sound and analyzed the data. LC and MA was integral in the design and execution of the project. All authors discussed the final results and contributed to the final manuscript.

Corresponding author

Correspondence to Michael G. Baracy Jr..

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The author declares that they have no conflict of interest.

Ethics approval

This study was given the determination of not human subjects research by the Ascension St. John Institutional Review Boards (IRB) on 03/02/2022 (Reference #1876078).

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Baracy, M.G., Kerl, A., Hagglund, K. et al. Trends in surgical approach to hysterectomy and perioperative outcomes in Michigan hospitals from 2010 through 2020. J Robotic Surg 17, 2211–2220 (2023). https://doi.org/10.1007/s11701-023-01631-w

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  • DOI: https://doi.org/10.1007/s11701-023-01631-w

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