Gynecologic Surgery Proportion and Utilization Trends in the NSQIP Database from 2010 through 2015 with Correlation to Technology and Policy

Objective: To assess the volume and temporal trends in utilization of gynecologic surgery codes between 2010 and 2015. Study design: The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) was queried to determine the frequency of individual gynecologic surgical procedures from 2010 to 2015. The National Inpatient Sample was used to further define the frequency of minimally invasive hysterectomies from 2012 to 2016. Data were analyzed using linear regression and chi-squared tests. Results: Gynecologic procedures represented 6.8% (95% confidence interval 6.8-6.9) of all surgical procedures included in the NSQIP database from 2010 through 2015 and this percentage was stable during the study period. The top 10% of procedures make up similar to 70% (66.5%-71.2%) of all procedures performed. The top 40% of procedures make up similar to 97% (96.8%-97.5%) of all procedures. Although hysterectomy codes were consistently among the top 10 most utilized codes, significant trends were observed in utilization related to the route of hysterectomy with rise of total laparoscopic hysterectomy (TLH). This was correlated with increasing adoption of robotic-assisted laparoscopy and decline of total vaginal hysterectomy (TVH) and abdominal hysterectomy (p < 0.001). There was also a large increase in concomitant adnexal surgery at the time of TLH, which potentially mirrors the recent rise in opportunistic salpingectomy. Conclusion: In this analysis, we highlight changes in the utilization of different gynecologic procedures to inform policy makers of challenges to appropriate reimbursement for laparoscopic procedures and a potential skills loss in open and vaginal procedures.

Automated summary

The study found that gynecologic procedures accounted for 6.8% of all surgical procedures from 2010 to 2015 and remained stable during the study period. The top 10% of procedures made up around 70% of all procedures, while the top 40% constituted approximately 97% of all procedures. Additionally, there was a significant trend towards an increase in total laparoscopic hysterectomy (TLH) and a decrease in total vaginal hysterectomy (TVH) and abdominal hysterectomy, potentially reflecting a shift in surgical practices.