Comparison of surgical indications for hysterectomy by age and approach in 4653 Chinese women

Abstract

Approximately one million hysterectomies are performed each year in China. However, national data regarding the indications and the surgical approaches for hysterectomy are lacking. The aim of this study was to examine the surgical indications for hysterectomy in different age groups and the relative merits of different surgical approaches for hysterectomy in Chinese women. Clinical data from 4653 cases of hysterectomy performed in Tongji Hospital from 2004 to 2009 were analysed. Hysterectomy was most commonly performed among women aged 40--49 years (2299; 49.4%). Overall, colporrhagia and abdominal pain were the two most common indications for hysterectomy. The most common indications by age groups were as follows: malignant ovarian tumour,<20 years; malignant uterine tumour, 20--29 and 30--39 years; uterine myoma, 40--49 and 50--59 years; and uterine prolapse, 60--69 and>70 years. The proportion of malignant aetiology also varied by age, being the highest in women aged<20 years (75.0%) and the lowest in those aged 40--49 years (19.9%). Approximately 35% women who had hysterectomies also had concomitant bilateral oophorectomy. The lowest rate of oophorectomy occurred in women aged 30--39 years (15.8%), whereas the highest rate was in those aged 50--59 years (75.9%). The abdominal surgical approach was used in 84% of all hysterectomies. Surgeries using the vaginal approach required a significantly shorter operating time (118 min average) than all other approaches (P<0.05). Both the amount of bleeding and the blood transfusion volume required were smaller in vaginal approaches, with no significant differences between the others. The surgical approaches used were also related to the scope of surgery. Both the surgical indications and the rates of bilateral oophorectomy varied by age. In terms of both operating time and the amount of bleeding and blood transfusion volume required, the vaginal approach was superior to all other surgical approaches.

Keywords

hysterectomy / surgical indications / surgical approach / bilateral oophorectomy

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Acknowledgements

This work was supported by a grant from the Ministry of Science and Technology of China for International S&T Cooperation Program of China (No. 2013DFA31400).

Compliance with ethics guidelines

Jingjing Jiang, Ting Ding, Aiyue Luo, Yunping Lu, Ding Ma and Shixuan Wang declare that they have no conflict of interest related to this study. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). The study was approved by the Ethics Committees of Tongji Hospital. The data collection was performed as a routine clinical workup without any interventions, and the data management and statistical analyses were processed anonymously. For these reasons, the Ethics Committees of Tongji Hospital waived the requirement for written informed consent.

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2014 Higher Education Press and Springer-Verlag Berlin Heidelberg