Downward Trends in OB/GYN Procedures

Do you find that your practice is doing fewer surgeries now than about 10 years ago? If so, your experience is in line with what is happening in OB/GYN surgery at hospitals across the country.

The Agency for Healthcare Research and Quality published their data on the surgeries done on patients in an OR between 2002 and 2013 as part of the Healthcare Cost and Utilization Project (HCUP). The data was stratified a number of different ways to determine which procedures were increasing and which were decreasing amongst patients in the United States. Procedures included were those that were done on inpatients and performed in the OR. Maternal and neonatal hospitalizations were excluded from the analysis. The top 10 surgical procedures in 2012 are shown in the Table.

While certain types of surgeries-including gastrectomy and knee arthroplasty-have increased, some OB/GYN surgeries are on the decline. In fact, of the top 10 procedures that have increased in frequency, none were OB/GYN surgeries. However, of the top 10 procedures that are decreasing at the greatest rate, four of them are OB/GYN-related. Oophorectomy, both unilateral and bilateral, decreased 54% between 2003 and 2012. Hysterectomy, which included procedures done through open surgery and those done vaginally, decreased 51% over the same time period. The two less frequently performed OB/GYN surgeries that were also found to be decreasing are genitourinary incontinence procedures and vaginal obliteration. These procedures decreased at an even greater rate between 2002 and 2013, at 62.5% for genitourinary incontinence and 59% for vaginal obliteration.

For the OB/GYN procedures on the decline since 2002, the decrease was found across most age groups. Incontinence procedures decreased in the groups aged 18 to 44 years, 45 to 64 years, and 65 to 84 years. Vaginal obliteration surgery also decreased in the same age groups. However, in the 85 years and older group, lumpectomy and mastectomy were the OB/GYN procedures that showed the largest decrease. There were no OB/GYN surgeries that increased in any age group.

Procedures broken out by payer were fairly consistent in respect to OB/GYN surgeries, with hysterectomy being in the top 5 most frequently done in Medicaid, privately insured, and uninsured patients. Vaginal obliteration and incontinence procedures were the only OB/GYN procedures in the top 5 of decreasing procedures. The rate of vaginal obliteration procedures decreased in Medicare and privately insured patients, while incontinence procedures decreased in privately insured patients.

References:

Fingar KR (Truven Health Analytics), Stocks C (AHRQ), Weiss AJ (Truven Health Analytics), Steiner CA (AHRQ). Most Frequent Operating Room Procedures Performed in U.S. Hospitals, 2003-2012. HCUP Statistical Brief #186. December 2014. Agency for Healthcare Research and Quality; Rockville, MD. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb186-Operating-Room-Procedures-United-States-2012.pdf.