Trends in Use and Outcomes of Women Undergoing Hysterectomy With Electric Power Morcellation

Over several years, there has been increasing concern that use of electric power morcellation during hysterectomy for benign conditions may result in the spread of undetected malignancies. This concern led the US Food and Drug Administration (FDA) to issue a safety communication in April 2014 discouraging use of morcellation and, in November 2014, to recommend against use of this procedure in perimenopausal and postmenopausal women. However, some clinicians believe that avoiding morcellation would lead to a greater number of hysterectomies via laparotomy, with an increased risk of surgical complications. Trends in the route of hysterectomy, use of electric power morcellators, and prevalence of abnormal pathology were compared before and after the FDA’s safety warning in 2014. The Perspective database was used to identify women aged 18 to 95 years who underwent hysterectomy from 2013 to the first quarter of 2015. This database includes more than 500 hospitals across the United States and 15% of hospitalized patients. A total of 203,520 women were identified, including 117,653 women (57.8%) who underwent minimally invasive hysterectomy. Among these minimally invasive hysterectomies, power morcellation was used in 13.5% in the first quarter of 2013, peaked at 13.7% by the last quarter of 2013, and declined sharply to 2.8% by the first quarter of 2015 (P< 0.001). During the same time, use of abdominal hysterectomy increased from 27.1% of procedures in early 2013 to 31.8% by the first quarter in 2015 (P = 0.004). Despite increased use of abdominal hysterectomy, the complication rate did not change over time (8.3% during the first quarter of 2013 and 8.4% during the last in 2015: difference, 0.1%; P = 0.53 for trend). The rate of complications during abdominal hysterectomy decreased from 18.4% in the first quarter of 2103 to 17.6% in the first quarter of 2015 (difference, −0.9%; P < 0.001 for trend). Complications were stable during minimally invasive hysterectomy (4.4% in 2013 and 4.1% in 2015: difference, −0.4%; P = 0.71 for trend) and vaginal hysterectomy (4.7% in 2013 and 4.2% in 2015: difference, −0.6%; P = 0.45 for trend). Over the study period, the prevalence rates of uterine cancer, endometrial hyperplasia, other gynecologic cancers, and uterine tumors of indeterminate behavior were unchanged among women who underwent minimally invasive hysterectomy with power morcellation. These data show that use of electric power morcellation declined after the FDAwarning, and use of abdominal hysterectomy increased. The FDAwarnings may result in a lower prevalence of cancer because of greater scrutiny on patient selection in women who undergo morcellation. However, the high rates of abnormal pathology after the warnings demonstrate the difficulty in the preoperative detection of uterine pathology.