Outcome and resource use associated with myomectomy (original) (raw)
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Obstetrics and Gynecology, 2001
OBJECTIVE:To evaluate the outcomes and cost of myomectomy through retrospective claims data analysis.METHODS:The study was performed using a retrospective database of private insurance claims from 1995 to 1997. Records were selected for analysis based on the presence of ICD-9-CM procedure and/or CPT-4 codes associated with myomectomy. In addition, diagnosis of uterine leiomyoma and related symptoms for these patients were confirmed through ICD-9-CM diagnosis codes. Inpatient, outpatient, and physician costs were estimated. All cost data were converted into 1997 dollars.RESULTS:A total of 4394 women, between the ages of 14 and 70, were available for analysis. Of these, 3305 were classified by type of myomectomy procedure, and complete data were available on 820 at 1 year and 236 at 2 years. Abdominal myomectomies were the most common procedures, followed by hysteroscopic and laparoscopic myomectomies. Conversion to a more invasive procedure occurred in 5.4% of the patients. The rate of additional surgeries was 8.3% in 6 months, 10.6% in 1 year, and 16.5% in 2 years. Overall cost increased from an initial 6,737perpatientto6,737 per patient to 6,737perpatientto7,575 in 1 year and to $8,001 in 2 years.CONCLUSION:The repeat procedures required after the initial myomectomy add significantly to total cost and highlight the importance of assessing post-procedure health care use. This comprehensive analysis facilitates the systematic evaluation of myomectomy with current and emerging alternative treatments for uterine leiomyomas.
Sultan Qaboos University Medical Journal, 2014
(NHS), as a share of national income, has more than doubled, rising by an average of 4% a year in real terms. This period of rapid growth has now ended, but funding pressures on the NHS continue to rise igniting a debate on the most cost-effective way of offering treatment. In this context, we audited subtotal abdominal hysterectomy (STAH) and laparoscopic-assisted supra-cervical hysterectomy (LASH) for benign gynaecological indications in a large district general hospital. A retrospective audit was undertaken of records of patients who had STAH or LASH for benign conditions at Wishaw General Hospital between August and July 2012. Twenty-five patients for each procedure were identified from the theatre information system. As three sets of notes could not be traced, there were 22 patients in the STAH group and 25 in LASH group. The mean operating time for STAH was 61 min (34-85 min) and 145 min (75-237 min) for the LASH group. There was one major complication in the STAH group (1,000 ml blood loss) compared to five in the LASH group (a pelvic infection, two wound infections and two patients with neuropathic pain at port sites). The mean hospital stay in the STAH group was 2.5 nights (2-4 nights) and 2 nights for patients undergoing LASH (1-4 nights). Costs were £2,213.40 (= OMR 1420) for STAH and £2,613.80 (= OMR 1677) for LASH. In this study, complication rates and apparent costs seemed comparable. Shorter hospital stays and possibly quicker recovery are areas where the laparoscopic approach scores over open surgery. In days of austerity for the NHS, surgery options need careful consideration. Open surgery's shorter operating times will help tackle long waiting lists but, if the impact on post-operative recovery and time off work are considered, the laparoscopic approach might be better.
High cumulative incidence of uterine leiomyoma in black and white women: Ultrasound evidence
American Journal of Obstetrics and Gynecology, 2003
OBJECTIVE: Uterine leiomyoma, or fibroid tumors, are the leading indication for hysterectomy in the United States, but the proportion of women in whom fibroid tumors develop is not known. This study screened for fibroid tumors, independently of clinical symptoms, to estimate the age-specific proportion of black and white women in whom fibroid tumors develop. STUDY DESIGN: Randomly selected members of an urban health plan who were 35 to 49 years old participated (n = 1364 women). Medical records and self-report were used to assess fibroid status for those women who were no longer menstruating (most of whom had had hysterectomies). Premenopausal women were screened by ultrasonography. We estimated the age-specific cumulative incidence of fibroid tumors for black and white women. RESULTS: Thirty-five percent of premenopausal women had a previous diagnosis of fibroid tumors. Fiftyone percent of the premenopausal women who had no previous diagnosis had ultrasound evidence of fibroid tumors. The estimated cumulative incidence of tumors by age 50 was >80% for black women and nearly 70% for white women. The difference between the age-specific cumulative incidence curves for black and white women was highly significant (odds ratio, 2.9; 95% CI, 2.5-3.4; P < .001). CONCLUSION: The results of this study suggest that most black and white women in the United States develop uterine fibroid tumors before menopause and that uterine fibroid tumors develop in black women at earlier ages than in white women. (Am J Obstet Gynecol 2003;188:100-7.)
Intra and Postoperative Morbidity Associated with Myomectomy
Bahrain Medical Bulletin
Myomectomy as an organ-preserving procedure has become an established alternative to hysterectomy 1-3. An increasing number of women in their fourth to fifth decade request conservative surgery to preserve their reproductive potential 2,3. New advances in assisted reproductive techniques permit women in later reproductive years to bear a child if the uterus is still intact. Submucous and intramural myoma decreases fertility and its removal is beneficial and necessary when the myoma is
Ginekologia polska, 2015
Myomas in pregnancy are associated with a significantly higher risk for cesarean section (CS). Cesarean myomectomy (CM), i.e. myomectomy during cesarean section, has been the source of much debate and was considered relatively contraindicated for many years. However, some authors advise to perform routine myomectomy during CS. The aim of our study was to determine factors influencing the intraoperative decision to perform CM. A total of 185 patients with uterine myomas, who delivered by caesarean section during a 5-year period, were included in the study--102 patients underwent CM (study group) and 83 women underwent CS without myomectomy (control group). Clinical and obstetric data were recorded and processed for analysis. Using non-parametric correlation methods, we investigated the influence of different variables on the decision to perform CM. No differences were recorded between the two groups in terms of parity fetal presentation, gestational age, number of previous laparotomi...
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2012
To compare short-term morbidity and quality of life after laparoscopic hysterectomy (LH) and laparoscopic myomectomy (LM) for the treatment of symptomatic uterine leiomyomas. We performed a prospective, observational study of women who were eligible for both surgical procedures. After informed consent was obtained, each participant was asked to complete the SF-12v2 Health Survey before surgery and to repeat it seven days and 28 days after surgery. Data on short-term morbidities, such as operative time, blood loss, length of hospital stay, and surgical complications, were collected by an obstetrician-gynaecologist. Women who underwent LH were compared by non-parametric statistical analyses with those who underwent LM. Sixty-one women were recruited between January 1 and December 31, 2008, including 40 who underwent LM and 21 LH. Women who underwent LH were older, had higher parity, and were less likely to have infertility than those who chose LM. Median LH operative time of 223 minut...
Myomectomy Revisited: Experiences in a Teaching Hospital
Journal of Nepal Medical Association, 2016
Introduction: Uterine myomas are the most common benign tumors of the female reproductive tract with myomectomy being one of the major modalities of the treatment in our set up. The aim of this study was to share the experiences of open myomectomy from a Teaching Hospital.Methods: A observational study was conducted from a records of myomectomy cases in the department of Obstetrics and Gynaecology at Nobel Medical College teaching Hospital from June 2014- May 2016.Results: Total 38 cases of myomectomy were performed during the study period in the women most commong age group being 35-39 years, followed by 30-34. The most common presenting symptoms was abnormal uterine bleeding in 15 (39.47%) followed by mass per abdomen in 10 (26.31%). The most common location of the myoma was intramural followed by subserosal, submucus. Degeneration was also noted in majority of the cases. All the myomectomies were done with Inj Vasopressin injected paracervically except in one case where tournique...
Myomectomy: a retrospective study to examine reproductive performance before and after surgery
Human Reproduction, 1999
The aim of this retrospective study was to establish the impact of myomectomy on pregnancy outcome with particular reference to its effect on the incidence of pregnancy loss. Myomectomy was performed using microsurgical procedures upon 51 women who had intramural or subserosal fibroids and wished to conceive. Overall, the conception rate following myomectomy was 57%. Multiple regression analysis showed that age was the only factor which influenced conception rate: ഛ35 years, 74% (23/31); ജ36 years, 30% (6/20; P Ͻ 0.005). The pregnancy loss rate prior to myomectomy was 60% (24/40), which was reduced to 24% (8/33) after myomectomy (P Ͻ 0.001). There was no instance of premature labour or scar rupture among 25 live births. This retrospective study suggests that myomectomy for intramural and subserosal fibroids may significantly improve the reproductive performance of women presenting with infertility or pregnancy loss.
The Laparoscopic Myomectomy: A Survey of Canadian Gynecologists
Journal of Minimally Invasive Gynecology, 2008
To survey all gynaecologists in Canada to determine the number who perform or offer the laparoscopic myomectomy (LM) procedure, the barriers that deter gynaecologists from performing or offering LM, and to understand the perceptions and attitudes of Canadian gynaecologists with respect to LM. A survey was developed, pre-tested, and distributed to all 1279 obstetrician-gynaecologists on the SOGC mailing list in April 2007. A total of 529 obstetrician-gynaecologists participated in the survey a response rate of 41.4%. Of the 485 respondents who practised gynaecology, 119 (24.5%) performed LM, but only 15 (3.1%) stated that more than 50% of their myomectomies were performed laparoscopically. Two hundred twelve gynaecologists (44.3%) admitted to having referred a patient to another gynaecologist for LM. Laparoscopic surgeons felt the principal barrier to performing LM was lack of training in the procedure (70.7%). Gynaecologists felt the principal barrier to referring to another gynaecologist for LM was their uncertainty about who offered the procedure (33%). The majority of gynaecologists believed that LM has faster recovery time. The majority of respondents, however, were unsure which procedure is superior with respect to blood loss, adhesion formation, fertility rate post-procedure, uterine rupture rate in subsequent pregnancy, and cost-effectiveness. Despite existing evidence that indicates that LM is comparable to abdominal myomectomy with respect to complication rates and fertility, only one quarter of Canadian gynaecologists who responded to this survey performed the procedure. Barriers to performing LM included lack of training and barriers to referral included uncertainty about who offered the procedure.