Inpatient Surgical Treatment Patterns: RESULTS

16 Nov
2009

Population Characteristics

Overall, for patients hospitalized with any uterine fibroid diagnosis, there were 2,136,151 admissions over the five-year period. The number of patients with any uterine fibroid diagnosis on their discharge record increased an average of 4.0% per year. For more than 50% of this subset, the primary diagnosis was uterine fibroids (Table 1). Patients with a primary diagnosis of fibroids had an average LOS of 2.73 days (SD=1.91, range 0-346), an average of 4.5 diagnoses (SD=2.3, range 1-25) and 2.2 procedures (SD=1.1, range 0-16) based on inpatient records.

Table 1. Inpatient admissions in U.S. hospitals for uterine fibroids, HCUP-NIS, 1998-2002

Percent Change

1998

1999

2000     2001

2002

Total      1998-2002
Diagnosis of uterine fibroid

338,985

404,415

435,076 439,223

467,542

2,136,151       20.2%
Primary diagnosis of uterine fibroids

223,825

238,018

255,457 254,753

264,416

1,236,469       18.1%

The majority of patients in the sample were white followed by blacks, Hispanics, Asians/Pacific Islanders, Native Americans and other races. Based on population means, black patients were younger and experienced a longer LOS compared with other racial groups. Hispanic patients were more likely to have Medicaid listed as their primary payer when compared with other groups (Table 2). viagra jelly online

Table 2. Demographic and medical characteristics of discharges with a primary diagnosis of uterine fibroids by race in the 1998-2002 HCUP-NIS

WhiteBlackHispanicAsian/Pacific Islander
CharacteristicN=512,647N=254,930N=78,185N=26,553
Mean age (years)45.341.843.344.4
Mean LOS (days)2.563.022.852.82
Insurance (%)
Medicare3.73.12.61.7
Medicaid3.610.914.76.3
Private/HMO87.777.771.085.4
Self-pay/other1.93.85.43.9
No charge3.04.56.32.7
Median Income of the Patient’s ZIP Code (%)
<$25,0002.112.711.51.5
$25/000-$35,00020.629.125.77.8
$35,000-$45,00028.027.226.619.3
>$45,00049.331.036.271.4
Region (%]
Northeast24.119.719.415.7
South18.410.91.31.8
Midwest36.959.439.315.8
West20.710.040.066.7
Total number of procedures on each2.252.072.192.17
inpatient record
Total number of diagnoses on each4.584.634.284.14
inpatient record

Processes of Care
For inpatients with a primary diagnosis of uterine fibroids, 322 distinct procedures were identified. However, 95.1% of the inpatients were treated with one of five procedures: 1) total abdominal hysterectomy (TAH) (62.2%), 2) uterine myomectomy (11.2%), 3) other vaginal hysterectomy (10.0%), 4) laparoscopical-ly assisted vaginal hysterectomy (LAVH) (6.3%), and 5) supracervical hysterectomy (SCH) (5.4%). Shows the rate per 1,000 discharges for each of the most common procedures over the five-year study period for patients with a primary diagnosis of uterine fibroids. TAH was by far the most common procedure performed. Women with a primary diagnosis of uterine fibroids were approximately seven times more likely to be treated with a hysterectomy than a myomectomy. The rate of SCH increased 181% over the five-year study period but never reached the frequency of TAH. The rate of myomectomies increased by 13% over the study period. The procedure associated with the longest LOS was TAH followed by SCH and myomectomy (Table 3).
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Table 3. Mean LOS by selected surgical procedure for patients with a primary diagnosis of uterine fibroids

Procedure      Mean LOS (Days)

Range (Days)

TAH                        2.97

0-67

SCH                       2.92

0-180

LAVH                       1.83

0-30

Myomectomy         2.74

0-346

Other hysterectomy  1.91

0-23

Inpatient discharges for women age <30 were more likely to be associated with myomectomy. Compared with women under 30, women in their 30s were 3.2 times less likely to have a myomectomy, while women in their 40s were 29.9 times less likely. Women in their 40s were 29.5 times more likely to have a procedure code for hysterectomy than women <30 years old. A comparison of the major types of hysterectomies suggests that older women are more likely to be treated with a TAH. Compared to women age <30, women who are in their 50s were 12 times more likely to be treated with TAH.

The results of the logistic regression odds ratios suggest that after controlling for patient and hospital characteristics, a wide variation exists in uterine fibroid treatment patterns across race. Compared with white women, all other races were significantly less likely to be treated with any type of hysterectomy. Asians/Pacific Islanders and black women were the least likely, respectively. In contrast, when compared with white women, all other races were more likely to be treated with myomectomy. The likelihood ranged from Hispanic women, who were 5% more likely than white women to be treated with a myomectomy, to Asian/Pacific-Island women, who were 91% more likely to be treated with a myomectomy. Black women were 62% more likely to have a myomectomy than white women. Make your pharmacy dollar go further and buy benicar 40 mg online

Black women had significantly higher rates of SCH than white women. Hispanic women had a SCH rate 3.1% below white women, while the rate for Asians/Pacific Islanders was 6.4% lower. White women had the highest rate for LAVH and the third highest rate for TAH. Overall, both Hispanic women and Asians/Pacific Islanders experienced a TAH rate higher (9% and 1% respectively) than white women, although Asians/Pacific Islanders had TAH rates which were not significantly different from white women. For laparoscopically assisted procedures, all races had rates that were significantly below white women, with black women being 69.5% less likely to have LAVH than white women (Table 4).

Table 4. Logistic regression odds ratios and confidence intervals for patients with a primary diagnosis of uterine fibroids by race

SCH

TAH

LAVH     Other Hysterectomy Myomectomy
OR      95% CI

OR     95% CI

OR     95% CI    OR    95% CI    OR     95% CI
White Black Hispanic

Asian/Pacific Islander

1.00        ref 1.34*    1.32-1.37 0.97    0.94-1.01 0.93*** 0.89-O.991.00             ref

0.88* 0.87-0.89

1.09* 1.07-1.11

1.01       0.98-1.04

1.00       ref      1.00      ref      1.00      ref 0.59*  0.58-0.61  0.64* 0.63-0.65  1.62* 1.60-1.65 0.75*  0.72-0.78 0.93* 0.9СЮ.95  1.05**1.02-1.07 0.68*  0.64-0.73 0.59* 0.56-0.62  1.91* 1.84-1.99
OR: odds ratio; ref: reference; * p value<0.001; **K p value <0.01; *** p value O.05

When discharges are controlled by patient age, all types of procedures were more common in private/HMO patients compared with Medicare patients. Medicaid patients were significantly more likely to be treated with a hysterectomy and less likely to be treated with a myomectomy when compared with private/HMO patients (Table 5).
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The variable “median household income for the ZIP code from which the patient originates” approximates the health resources available in the area and the socioeconomic status of the community. With the exception of the lowest income level (<$25,000 per year), an inverse relationship was identified between income and rates for hysterectomy. Hospital discharge data indicate that patients with an income level of >$45,000 per year were more likely to be treated with myomectomy (Table 5).

Table 5. Logistic regression odds ratios and confidence intervals for patients with a primary diagnosis of uterine fibroids for patient characteristics

Variable

Any Type of Hysterectomy

Myomectomy
Odds Ratio           95% CI

Odds Ratio

95% CI

Payer Type
Private/HMO1.00

reference

1.00

reference

Medicare0.80*

0.76-0.83

0.78*

0.73-0.82

Medicaid1.21*

1.18-1.23

0.37*

0.36-0.39

Self-pay0.76*

0.74-0.78

0.64*

0.62-0.66

No Charge1.60*

1.44-1.78

0.42*

0.37-0.48

Other Insurance1.23*

1.19-1.28

0.67*

0.64-0.70

Region
Northeast1.00

reference

1.00

reference

Midwest1.90*

1.87-1.94

0.52*

0.51-0.53

South1.55*

1.53-1.57

0.75*

0.73-0.76

West1.17*

1.15-1.19

0.82*

0.80-0.84

Median income
<$25,0001.00

reference

1.00

reference

$25,000-$35,0001.31*

1.28-1.34

0.81*

0.79-0.83

$35,000-345,0001.11*

1.08-1.13

1.02

0.99-1.04

>$45,0000.80*

0.79-0.82

1.51*

1.47-1.55

* p value <0.001

Myomectomies were more common in the northeast compared with the midwest, south and western regions of the country. Hysterectomies (with the exception of SCH) were less common in the northeast region. Patients discharged from larger hospitals were less likely to have been treated with a hysterectomy than patients from either small or medium-sized hospitals. Patients discharged from teaching hospitals were more likely to have been treated with a myomectomy than those discharged from nonteaching hospitals (Table 6).
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Table 6. Logistic regression odds ratios and confidence intervals for patients with a primary diagnosis of uterine fibroids for hospital characteristics

VariableAny Type of HysterectomyMyomectomy
Odds Ratio95% CIOdds Ratio

95% CI

Hospital Bed Size
Large1.00

reference

1.00

reference

Medium

1.21*

1.19-1.23

0.80*

0.79-0.81

Small

1.54*

1.50-1.57

0.68*

0.66-0.69

Teaching hospital

0.54*

0.54-0.55

1.88*

1.85-1.91

For-profit hospital

0.88*

0.86-0.90

1.09*

1.06-1.12

* p value<0.001
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