Inpatient Laparoscopic Hysterectomy in the United States: Trends and Factors Associated With Approach Selection
Inpatient Laparoscopic Hysterectomy in the United States: Trends and Factors Associated With Approach Selection
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DOI：
10.1016/j.jmig.2016.08.830
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发表时间：
2017-01-01
影响因子：
4.1
通讯作者：
Xu, Xiao
中科院分区：
文献类型：
--
作者：
Desai, Vrunda Bhaysar;Guo, Xiaoyue M.;Xu, Xiao
研究目的：研究不同腹腔镜入路在住院子宫切除术中的使用模式，并确定与选择特定腹腔镜入路相关的患者和医院特征。设计：使用 2007 年至 2012 年国家（全国）住院患者样本 (NIS) 的数据，我们根据国际分类确定了因非产科适应症而接受住院腹腔镜子宫切除术的成年女性。 疾病，第九次修订，临床修改代码。良性病例根据腹腔镜方法进行分类，分为全腹腔镜子宫切除术（TLH）、腹腔镜辅助阴式子宫切除术（LAVH）或腹腔镜宫颈上子宫切除术（LSH）。我们评估了 2007 年至 2012 年期间这些方法使用的变化，并使用多项 Logistic 回归来检查患者和医院特征与 2012 年腹腔镜方法选择之间的关联。NIS 样本权重用于生成具有全国代表性的估计值。设计分类：回顾性研究（加拿大工作组分类 III）。设置：全国医院住院护理。患者：NIS 中的成年女性患者 2007 年至 2012 年间接受住院腹腔镜子宫切除术的数据库。干预：住院腹腔镜子宫切除术。测量和主要结果：2012 年进行的住院腹腔镜子宫切除术中，83.2% 为良性适应症。 TLH 方法占所有腹腔镜子宫切除术的 48.3%，其次是 LAVH，占 37.3%，LSH 占 14.4%。 45.0% 的所有病例和 72.3% 的恶性子宫切除术中均报告有机器人辅助。对 2007 年至 2012 年时间趋势的检查表明，腹腔镜方法从 LAVH 转向 TLH，LSH 略有下降。患者种族/民族、收入、子宫切除术指征、合并症以及医院教学状况、城市/农村位置、床位大小、所有权类型和地理区域与腹腔镜手术方式的选择显着相关。 结论：良性腹腔镜子宫切除术越来越多地以 TLH 而非 LAVH 进行。除了临床因素外，腹腔镜入路的选择还受到患者社会经济和医院特征的影响。 (C) 2016 年由 Elsevier Inc. 代表 AAGL 发布。
Study Objective: To examine utilization patterns of different laparoscopic approaches in inpatient hysterectomy and identify patient and hospital characteristics associated with the selection of specific laparoscopic approaches.Design: Using data from the 2007 to 2012 National (Nationwide) Inpatient Sample (NIS), we identified adult women undergoing inpatient laparoscopic hysterectomy for nonobstetric indications based on International Classification of Diseases, Ninth Revision, Clinical Modification codes. Benign cases were categorized based on laparoscopic approach, classified as total laparoscopic hysterectomy (TLH), laparoscopic-assisted vaginal hysterectomy (LAVH), or laparoscopic supracervical hysterectomy (LSH). We assessed changes in the use of these approaches during 2007 to 2012, and used multinomial logistic regression to examine the association of patient and hospital characteristics with the choice of laparoscopic approach in 2012. The NIS sample weights were applied to generate nationally representative estimates.Design Classification: Retrospective study (Canadian Task Force classification III).Setting: Hospital inpatient care nationwide.Patients: Female adult patients in the NIS database who underwent an inpatient laparoscopic hysterectomy between 2007 and 2012.Intervention: Inpatient laparoscopic hysterectomy.Measurements and Main Results: Of the inpatient laparoscopic hysterectomies performed in 2012, 83.2% were for benign indications. The TLH approach accounted for 48.3% of all laparoscopic hysterectomies, followed by LAVH at 37.3% and LSH at 14.4%. Robotic assistance was reported in 45.0% of all cases and 72.3% of malignant hysterectomies. An examination of temporal trends during 2007 to 2012 demonstrates a shift in the laparoscopic approach from LAVH toward TLH, with a slight decrease in LSH. Patient race/ethnicity, income, indication for hysterectomy, and comorbid conditions, as well as hospital teaching status, urban/rural location, bed size, type of ownership, and geographic region, were significantly associated with the choice of laparoscopic approach.Conclusion: Benign laparoscopic hysterectomy is increasingly performed as TLH rather than LAVH. In addition to clinical factors, the selection of laparoscopic approach is influenced by patient socioeconomic and hospital characteristics. (C) 2016 Published by Elsevier Inc. on behalf of AAGL.