T. Andriotti1, D. Sturgeon1, M. K. Dalton1, E. Goralnick1,2, J. S. Weissman1, M. P. Jarman1 1Brigham And Women’s Hospital,Center For Surgery And Public Health/Department Of Surgery,Boston, MA, USA 2Brigham And Women’s Hospital,Department Of Emergency Medicine,Boston, MA, USA
Introduction: Hysterectomy is the most common non-pregnancy-related surgery performed on women in the US. After menopause, benign uterine diseases (i.e. fibroids, endometriosis) tend to subside due to hypoestrogenism. As a result, postmenopausal women with benign uterine diseases, low risk of gynecological cancer, and no genital prolapse may benefit the most from non-surgical treatment. It has been suggested that few postmenopausal hysterectomies may be indicated. Although there is prolific literature about cost and outcomes of hysterectomy for benign uterine diseases, little is known about similar measures more specifically in postmenopausal women. We sought to estimate the costs and outcomes of hysterectomy performed in women with benign uterine diseases after menopause.
Methods: We utilized the 2014 Healthcare Cost and Utilization Project National Inpatient Sample to identify individuals over age 50 (the mean age of menopause) undergoing an index inpatient hysterectomy (vaginal, abdominal, and laparoscopic) for benign uterine diseases. Weighted descriptive analyses were used to assess the distribution of total charges, utilization, and inpatient postoperative complications across primary payment sources (Medicaid, Medicare, private insured, uninsured). Inpatient postoperative complications were defined as a composite based on International Classification of Disease, Clinical Modification, 9th Edition [ICD9] diagnoses for index hospital infections and common surgical complications. We excluded records of hysterectomies with an associated diagnosis for gynecological cancers or genital prolapse
Results: Among US women over age 50, approximately 14,690 index hysterectomies for benign disease were performed in 2014. 5,228 (35.6%) were simple hysterectomies and 9,462 (64.4%) hysterectomies with bilateral or unilateral oophorectomies. The median total charges for the index surgical procedure were $46,152 (IQR: 30,068-73,659) in Medicare, $38,762 (24,538-61,128) in Medicaid, $35,132 (23,389-45,125) in private insured, and $38,930 (26,664-59,199) in uninsured. The median length of stay was 2 days for privately insured patients, and 3 days for Medicare, Medicaid, and uninsured patients. In addition, the proportion of postoperative complications during hospital stay was 17% in Medicare, 13% in Medicaid, 10% in private insured and 15% in uninsured.
Conclusion: Inpatient hysterectomies performed in postmenopausal women for benign uterine diseases expose patients to substantial risk from postoperative complications and incur significant hospital charges regardless of payment type. Further analyses of clinical decision making and outcomes from postmenopausal hysterectomy are needed to inform practice guidelines.