Decrease in Complications

A hysterectomy is the surgical removal of the uterus and sometimes the ovaries and fallopian tubes, too. Researchers analysed data from the California Patient Discharge Database for 649,758 women who underwent hysterectomy procedures between 1991 and 2004 in hospitals for benign, or non-cancerous, conditions.

The researchers found a 17.6 percent decrease in the total number of hysterectomies. The rate based on population declined as well. The team also found that the rates of surgical and medical complications declined significantly.

"In recent years, we've seen a rise in alternatives to treat and manage bleeding," lead author of the study Lloyd Smith said. "Heavy bleeding is increasingly treated using endometrial ablation, heat or other less invasive methods." Surgical methods have also changed, he said. Laparoscopic-assisted vaginal hysterectomy for benign uterine conditions has become more commonplace. This procedure involves a small incision in the abdomen through which much of the surgery to release the uterus is done before it is removed through the vagina. Traditional hysterectomy involves a large abdominal incision. The rate of this type of hysterectomy rose tenfold during the study period, while the complication rate fell significantly.

Better selection of good candidates for laparoscopic-assisted vaginal hysterectomy and increased surgeon proficiency likely contributed to a 50 percent decrease in complications associated with this type of hysterectomy during the study period.

The researchers also found that the rate of subtotal - or supra-cervical - hysterectomies rose 17-fold during the study period. Smith attributes this to a suggestion in medical literature (unsupported by data from controlled studies) that leaving the cervix in place lowers the impact on sexuality and future urinary problems. "Women are demanding it because they have seen these reports in the popular press. We saw a sharp increase in cases, but we also saw a decrease in complications," Smith said.

A negative result was that African-American women had higher rates of complications as well as readmissions to hospital when compared to non-Hispanic white women.

MEDICA.de; Source: University of California - Davis - Health System