Inpatient Surgical Treatment Patterns

14 Nov
2009

Inpatient Surgical Treatment Patterns

INTRODUCTION

Uterine leiomyomas (fibroids) are benign, often asymptomatic tumors derived from smooth muscles and the extracellular matrix proteins collagen and elastin. Signs and symptoms of uterine fibroids include heavy or prolonged menstrual bleeding, pain and pregnancy complications. Although patients with benign symptoms may be monitored without treatment, common surgical treatments include hysterectomy (abdominal, vaginal and laparoscopic) and myomectomy (laparotomy, laparoscopic and hystero-scopic). New approaches, such as myolysis, focused ultrasound, transvaginal cryomyolysis and uterine artery embolization (UAE), are being studied as possible alternative treatments. Uterine fibroids have been identified as the most common diagnosis associated with hysterectomy in the United States.

A population-based study of women age <50 found that 35% of premenopausal women had been diagnosed with fibroids, and 51% of women had evidence of fibroids on ultrasound without a prior diagnosis. The same study found that the age-specific cumulative incidence of uterine fibroids by age 50 was higher at all ages for black women compared with white women. The incidence of uterine fibroids in the Nurses Health Study II was 8.9 per 1,000 in white women and 30.6 per 1,000 for black women. The Black Women’s Health Study found that the incidence of uterine fibroids for black women was 29.7 per 1,000, with risk decreasing with age at menarche, parity and age at first birth and increasing with years since last birth. order cialis super active

Although uterine fibroids are a common condition, appropriate management is not clearly defined as demonstrated by regional variation in hysterectomy rates and inconsistent compliance with treatment guidelines. A number of studies have compared patient characteristics and clinical conditions in fibroid patients. Important covariates include age race and ethnicity, education and income, and uterine size. However, the impact of these factors has not been consistent across studies. Other qualitative research suggests that surgeon and patient preferences impact treatment decisions. This investiga-tion evaluates five years of national hospital data to address the impact of race, payer type, income, region and hospital characteristics on treatment patterns for hospitalized patients.

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