title: Surgical management of uterine fibroids in Hesse, Germany, between 1998 and 2004.
abstract: OBJECTIVE
  To identify and evaluate surgical management of women with uterine fibroids.
  
  
  METHODS
  Retrospective analysis of mandatory surgical data sent to the Institute for Quality Assurance.
  
  
  METHODS
  Data collection from 1998 to 2004 in Hesse, Germany.
  
  
  METHODS
  34,814 women who underwent surgery for uterine fibroids.
  
  
  METHODS
  Patients were treated with either myomectomy or hysterectomy.
  
  
  METHODS
  Statistical analysis of mandatory surgical parameters.
  
  
  RESULTS
  Altogether, 4975 (14.3%) women had myomectomies, and 29,839 (85.7%) had hysterectomies. Age was an important determinant of surgical procedure; hysterectomy was preferred for patients over 40 (odds ratio 4.3; 95% confidence interval: 4.1-4.5). Laparoscopic myomectomy rates increased from 25.9% in 1998 to 41.9% in 2004; during the same period, the proportion of conversion procedures and abdominal approaches fell from 15.6% to 2.9% and 38.9% to 30.9%, respectively. Intraoperative complication rates were similar for myomectomy (1.1%) and hysterectomy (1.0%), but postoperative complication rates were higher for hysterectomy (5.8%) than myomectomy (3.2%).
  
  
  CONCLUSIONS
  The increasing use of endoscopic procedures was an important feature in this series and appeared to be safe. The reduction of conversion rates and intraoperative complications might be related to improvements in surgical skill. Acceptance of the benefits of endoscopic approaches seems to have promoted its steady growth as a primary surgical approach.
authors.affiliation: Department of Obstetrics and Gynecology, Justus-Liebig-University of Giessen, Giessen, Germany. andreas.hackethal@gyn.med.uni-giessen.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Hackethal
authors.forename: Dörthe
authors.initials: D
authors.lastname: Brüggmann
authors.forename: Anne
authors.initials: A
authors.lastname: Leis
authors.forename: Swapnil
authors.initials: S
authors.lastname: Langde
authors.forename: Rosi
authors.initials: R
authors.lastname: Stillger
authors.forename: Karsten
authors.initials: K
authors.lastname: Münstedt
mesh_terms: D000328:Adult; D000367:Age Factors; D002983:Clinical Competence; D005260:Female; D005858:Germany / Q000453:epidemiology; D019538:Health Care Surveys; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data*; D010535:Laparoscopy / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data*; D007889:Leiomyoma / Q000453:epidemiology / Q000601:surgery*; D007902:Length of Stay; D008875:Middle Aged; D009215:Myometrium / Q000601:surgery*; D016017:Odds Ratio; D018579:Patient Selection; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000453:epidemiology / Q000601:surgery*