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OBJECTIVE: To examine the use of inpatient hysterectomy and explore changes in the use of various routes of hysterectomy and patterns of referral. METHODS: The Nationwide Inpatient Sample was used to identify all women aged 18 years or older who underwent inpatient hysterectomy between 1998 and 2010. Weighted estimates of national trends were calculated and the number of procedures performed estimated. Trends in hospital volume and across hospital characteristics were examined. RESULTS: After weighting, we identified a total 7,438,452 women who underwent inpatient hysterectomy between 1998 and 2010. The number of hysterectomies performed annually rose from 543,812 in 1998 to a peak of 681,234 in 2002; it then declined consistently annually and reached 433,621 cases in 2010. Overall, 247,973 (36.4%) fewer hysterectomies were performed in 2010 compared with 2002. From 2002 to 2010 the number of hysterectomies performed for each of the following indications declined: leiomyoma (-47.6%), abnormal bleeding (-28.9%), benign ovarian mass (-63.1%), endometriosis (-65.3%), and pelvic organ prolapse (-39.4%). The median hospital case volume decreased from 83 procedures per year in 2002 to 50 cases per year in 2010 (P<.001). CONCLUSION: The number of inpatient hysterectomies performed in the United States has declined substantially over the past decade. The median number of hysterectomies per hospital has declined likewise by more than 40%. [ABSTRACT FROM AUTHOR]

The article discusses a study which examined the associations among cytoreduction, perioperative complications and delay or omission of chemotherapy. It observes that cytoreductive surgery is associated with extensive morbidity and may delay chemotherapy. The article concludes that extended cytoreductive surgery and perioperative complications significantly delay initiation but do not increase the chance of omission of chemotherapy for women with ovarian cancer.

The article discusses a study on treating benign ovarian masses among adolescents. The study analyzed the factors that influence the use of laparoscopy and cystectomy to treat the condition, including patient, surgeon and hospital characteristics. The study concluded that the treatment of benign ovarian masses among adolescents is highly variable.

This article discusses a study which compared the performance of the 1988 and 2009 International Federation of Gynecology and Obstetrics (FIGO) staging systems for uterine corpus cancer. Researchers analyzed women with endometrioid adenocarcinoma of the uterus who were treated between 1988 and 2006 and whose cases were recorded in the Surveillance, Epidemiology and End Results database. The key findings and conclusion of the study are discussed.

The article discusses a study about the regionalization of care for obstetric hemorrhage and its effect on maternal mortality. Results revealed a 1.2 percent maternal mortality rate among the women who underwent peripartum hysterectomy. Findings also showed that women who underwent operation at high-volume hospitals had a 71 percent lower perioperative mortality rate, lower incidence of perioperative surgical complications, as well as lower rate of intensive care unit usage compared to those treated at low-volume facilities.

The article presents questions and answers related to surgical procedures in the U.S., including how often surgical instruments and sponges inadvertently retained in patients undergoing surgical procedures, the clinical presentation of a retained surgical sponge and the way the diagnosis is made, and the risk factors associated with retained surgical instruments/sponges.

The article discusses a study which compares the clinical behavior and outcome of uterine carcinosarcomas and grade 3 endometrioid cancers in the U.S. The study found that carcinosarcomas present at more advanced stage and have worse survival, as compared to grade 3 endometrioid cancers. Carcinosarcomas may represent a distinct biologic entity.

OBJECTIVE: To identify prognostic factors that may be used to predict an aggressive disease course and poor outcome in patients with epithelial ovarian tumors of low malignant potential (borderline tumors).METHODS: Data on 126 patients with ovarian borderline tumors were analyzed with regard to demographic characteristics, staging, presence of microinvasion, duration of follow-up, recurrence rate, rate of recurrence as invasive disease, mortality rate, preoperative and postoperative CA-125, and treatment. Chi-square and Fisher exact tests were used to evaluate proportions for statistical significance. Disease-free and overall survival was calculated by using the Kaplan–Meier method and log-rank test.RESULTS: Patients were followed for a median of 39.0 months (mean 47.8 months). Seven patients (5.6%) had recurrent disease. Advanced stage disease and microinvasion were associated with significantly higher recurrence and mortality rates than were stage I/II disease and borderline tumors without microinvasion, respectively. Two of 13 (15%, 95% CI 8.7, 21.3) patients with microinvasion died of recurrent invasive cancer, whereas only 1 out of 113 patients without microinvasion died of recurrent borderline tumor (OR 20.4, 95% CI 1.2, 239). All 3 patients with an aggressive disease course and poor outcome had increasing CA 125 levels at the time of recurrence.CONCLUSION: Certain patients with microinvasion may be at higher risk for recurrence as invasive disease and may require different treatment strategies. CA 125 monitoring may have a role in early detection of recurrence in patients with aggressive disease. [Copyright &y& Elsevier]

Objective: We analyzed use of venous thromboembolism (VTE) prophylaxis in patients undergoing oncologic surgery and examined the influence of surgeon and hospital characteristics on prophylaxis., Background: Cancer patients undergoing surgery are at high-risk for VTE. Despite the risk of VTE, the use of prophylaxis is variable. Little is known about the patient, surgeon, and hospital characteristics that influence the use of prophylaxis., Methods: Patients undergoing oncologic surgery from 2003 to 2007 and recorded in the Perspective database were analyzed. Surgeons and hospitals were stratified into volume-based tertiles for analysis. The effects of surgeon and hospital volume on use of any prophylaxis and pharmacologic prophylaxis were examined using generalized estimating equations adjusted for confounding variables., Results: In the cohort of 252,950 patients, some form of prophylaxis was given to 79% of patients whereas 46% received pharmacologic prophylaxis. The rate of VTE prophylaxis was 82.7% at high-volume hospitals compared with 75.6% at low-volume facilities (P < 0.0001). After adjustment for case mix and surgeon volume, the odds ratio for receipt of prophylaxis at high- versus low-volume hospitals was 1.40 (95% CI, 1.20-163). The odds ratio for prophylaxis for patients treated by high-volume surgeons was 1.35 (95% CI, 1.14-160) after adjusting for case mix and hospital volume. The rate of pharmacologic VTE prophylaxis was 53.1% in high-volume hospitals versus 38.8% in low-volume hospitals (P < 0.0001). Treatment at a high-volume hospital was associated with an odds ratio of 1.42 (95% CI, 1.22-1.66) for pharmacologic prophylaxis whereas the odds ratio for pharmacologic prophylaxis for patients treated by high-volume surgeons was 1.28 (95% CI, 1.08-1.51)., Conclusion: VTE prophylaxis is underutilized in patients undergoing oncologic surgery. Patients treated by high-volume surgeons and at high-volume hospitals are more likely to receive appropriate prophylaxis.

Objective: To examine adherence to evidence-based recommendations for preoperative testing and health care costs associated with excessive testing., Methods: An institutional review of women who underwent gynecologic surgery between 2005 and 2007 was performed. Data on the type of surgery, age, comorbidities, and perioperative testing was extracted. We noted the preoperative performance of chest X-ray, electrocardiogram, metabolic panel, complete blood count, coagulation studies, liver function tests, and urinalysis. Each test was classified as being guideline-based (appropriate) or non-guideline-based (inappropriate) as described by the National Institute of Clinical Excellence perioperative guidelines., Results: A total of 1,402 patients were identified. Ninety-five percent of patients underwent all of the guideline-recommended preoperative testing. Ninety percent of women underwent at least one nonindicated preoperative test. None of the 749 urinalyses, 407 liver function tests, or 1,046 coagulation studies performed was appropriate. Ninety-nine percent of the 427 chest X-rays ordered were inappropriate. Only 17% of metabolic panels, 36% of electrocardiograms, and 29% of complete blood counts were in accordance with evidence-based guidelines. Inappropriate perioperative tests led to a direct cost of more than $418,000. Of the inappropriate tests ordered, abnormalities were noted frequently but rarely changed management., Conclusion: Adherence to evidence-based recommendations for preoperative testing is poor. Inappropriate preoperative tests represent a major health care expenditure., Level of Evidence: III.