Hysterectomy Practice Patterns in the Postmorcellation Era

Abstract

Objective:

To characterize long-term national trends in surgical approach for hysterectomy following 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 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) from 2012 to 2016. We identified hysterectomies using Current Procedural Terminology (CPT) codes. We used an interrupted time-series analysis to evaluate abdominal and supracervical hysterectomy trends surrounding The Wall Street Journal (WSJ) article first reporting morcellation safety concerns and the FDA safety communication. We compared categorical and continuous variables using Chi-square, t and Wilcoxon rank-sum tests.

Results:

We identified 179,950 hysterectomies; laparoscopy was the most common mode of hysterectomy in every quarter. Until the WSJ article, there was no significant change in proportion of abdominal hysterectomies (0.3% decrease per quarter, p=0.14). After the WSJ article, use of abdominal hysterectomy increased 1.1% per quarter for two quarters through the FDA warning (p<0.001), plateaued for three quarters until March 2015 (p=0.65), then decreased by 0.8% per quarter through 2016 (p<0.001). Supracervical hysterectomy volume continuously decreased following the FDA warning (1.0% decrease per quarter, p<0.001) and following three quarters (0.7% decrease per quarter, p=0.01), then plateaued from April 2015 through 2016 (0.05% decrease per quarter, p=0.40). Mode of supracervical hysterectomy was unchanged from 2012 to 2013 (p=0.43), followed by two quarters of significant increase in proportion of supracervical abdominal hysterectomies (11.7% per quarter, p<0.001). This change in mode of supracervical hysterectomy then plateaued through 2016 (p=0.06).

Conclusion:

Despite early studies suggesting that minimally-invasive hysterectomy decreased in response to safety concerns regarding power morcellation, we found that this effect reversed one year following 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.

Precis

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