Trends in Various Types of Surgery for Hysterectomy and Distribution by Patient Age, Surgeon Age, and Hospital Accreditation: 10-Year Population-Based Study in Taiwan

Wu, Ming-Ping; Huang, Kuan-Hui; Long, Cheng-Yu; Tsai, Eing-Mei; Tang, Chao-Hsiun

doi:10.1016/j.jmig.2010.04.010

« Previous Next »The Journal of Minimally Invasive Gynecology
Volume 17, Issue 5 , Pages 612-619, September 2010

Trends in Various Types of Surgery for Hysterectomy and Distribution by Patient Age, Surgeon Age, and Hospital Accreditation: 10-Year Population-Based Study in Taiwan

Ming-Ping Wu, MD, PhD
- Division of Uroynecology and Pelvic Floor Reconstruction, Department of Obstetrics and Gynecology, Chi Mei Foundation Hospital, Tainan, Taiwan
- College of Medicine, Taipei Medical University, Taipei, Taiwan
Kuan-Hui Huang, MD
- Division of Gynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
Cheng-Yu Long, MD, PhD
- Department of Obstetrics and Gynecology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
Eing-Mei Tsai, MD, PhD
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Corresponding authors: Chao-Hsiun Tang, PhD, School of Health Care Administration, Taipei Medical University, 250 Wu-Xin St, Taipei 110, Taiwan; Eing-Mei Tsai, MD, PhD, the Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Shih-Chuan Road, San-Ming Dist., Kaohsiung, Taiwan.
- Both authors contributed equally to this work.
Chao-Hsiun Tang, PhD
- School of Health Care Administration, Taipei Medical University, Taipei and the Gynecology Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Corresponding authors: Chao-Hsiun Tang, PhD, School of Health Care Administration, Taipei Medical University, 250 Wu-Xin St, Taipei 110, Taiwan; Eing-Mei Tsai, MD, PhD, the Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Shih-Chuan Road, San-Ming Dist., Kaohsiung, Taiwan.
- Both authors contributed equally to this work.

Received 23 February 2010; accepted 23 April 2010. published online 26 July 2010.

Abstract

Study Objective

To estimate the trends in various types of hysterectomy (abdominal, vaginal, laparoscopic, and subtotal) and their distribution according to patient age, surgeon age, and hospital accreditation in Taiwan.

Design

Retrospective cohort study (Canadian Task Force classification II-2).

Setting

Population-based National Health Insurance (NHI) database.

Patients

Women with NHI in Taiwan undergoing various types of hysterectomy to treat noncancerous lesions.

Interventions

Data for this study were obtained from the Inpatient Expenditures by Admissions files of the NHI research database, released by the NHI program in Taiwan for 1996–2005.

Measurements and Main Results

A total of 234939 women who underwent various types of hysterectomy were identified for analysis. The number of hysterectomies performed annually remained stationary during the 10-year study. Total abdominal hysterectomies decreased significantly (77.33% in 1996 vs 45.68% in 2005), laparoscopic hysterectomies increased significantly (5.20% vs 40.40%), vaginal hysterectomies decreased (14.70% vs 8.86%), and subtotal abdominal hysterectomies increased (2.76% vs 5.06%). Laparoscopic hysterectomy was more commonly performed in middle-aged women; vaginal hysterectomy was more common in older women; and subtotal abdominal hysterectomy was more common in younger women. Laparoscopic hysterectomy was performed more commonly in regional hospitals (33.11%), followed by medical centers (30.17%) and local hospitals (17.78%). Laparoscopic hysterectomy was performed more commonly in not-for-profit hospitals (30.25%), followed by private hospitals (29.32%) and government-owned hospitals (25.91%).

Conclusion

There has been considerable change in the types of surgery used for hysterectomy in Taiwan over the past 10 years. As a minimally invasive approach, laparoscopic hysterectomy represents a profound change for both patients and surgeons.

Keywords: Abdominal hysterectomy, Laparoscopic hysterectomy, National Health Insurance, National Health Insurance research database, Subtotal abdominal hysterectomy, Total abdominal hysterectomy, Vaginal hysterectomy