Primary and Repeated Surgeries for Ectopic Pregnancies and Distribution by Patient Age, Surgeon Age, and Hospital Levels: An 11-Year Nationwide Population-Based Descriptive Study in Taiwan

Ming I. Hsu, Chao Hsiun Tang, Pei Yang Hsu, Yu Tung Huang, Cheng Yu Long, Kuan Hui Huang, Ming-Ping Wu

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Study Objective: To describe the changing trend, repeat operation rate, and distribution of laparoscopy, as compared with laparotomy, in treating ectopic pregnancy, according to patient age, preoperative conditions, surgeon age, and hospital accreditation level, in Taiwan over 11-years. Design: Retrospective cohort study (Canadian Task Force classification II-2). Setting: Population-based nationwide insurance database. Patients: Women who underwent either laparotomy or laparoscopy because of ectopic pregnancy. Interventions: Women who had National Health Insurance (NHI) underwent various surgical procedures to treat ectopic pregnancy. Data for this study were obtained from the Inpatient Expenditures by Admissions files of the NHI Research Database, released by the NHI program in Taiwan between 1997 and 2007. Measurements and Main Results: A total of 43 170 women with 44 928 operations were identified. Only the primary surgeries, via either laparotomy or laparoscopy, performed because of ectopic pregnancy were included for analysis. The annual number of procedures to treat ectopic pregnancies decreased in the later years of the 11-year study. Laparotomy decreased significantly, from 81.2% in 1997 to 26.2% in 2007, whereas laparoscopic procedures increased significantly, from 18.8% in 1997 to 73.8% in 2007, as evidenced at log-linear regression analysis (p <.001). The rate of repeat operations because of persistent ectopic pregnancy was higher in the laparoscopy group than in the laparotomy group (0.38% vs 0.14 %; p <.001). Patients were more likely to undergo the same type of operation for the repeated surgery (i.e., laparotomy to laparotomy in 73.1% or laparoscopy to laparoscopy in 80.2%; p = 0.43). Use of laparoscopy (58.1%) and laparotomy (41.9%) differed according to patient age, preoperative comorbidities, surgeon age, and hospital accreditation level and ownership type. With older patients, those with preoperative anemia or shock, and elder surgeons, there was a greater chance that laparotomy would be performed. The probability of undergoing laparotomy was greater in patients in regional hospitals, local hospitals, and office-based clinics compared with those in medical centers. Conclusions: There has been considerable change in the type of surgical approach used to treat ectopic pregnancy in Taiwan over the past 11 years. Laparoscopy is preferred to laparotomy, and has become the standard surgical approach to treating ectopic pregnancies in Taiwan. However, laparoscopy is associated with a higher rate of repeat operations. The laparoscopic approach signifies a profound change in treating ectopic pregnancies among patients, surgeons, and hospital types.

Original languageEnglish
Pages (from-to)598-605
Number of pages8
JournalJournal of Minimally Invasive Gynecology
Volume19
Issue number5
DOIs
Publication statusPublished - Sep 2012

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Ectopic Pregnancy
Age Distribution
Taiwan
Laparotomy
Laparoscopy
Population
National Health Programs
Accreditation
Surgeons
Databases
Ownership
Advisory Committees
Health Expenditures
Insurance
Comorbidity
Anemia
Inpatients
Linear Models
Shock
Cohort Studies

Keywords

  • Anemia
  • Ectopic pregnancy
  • Hemorrhagic shock
  • Hospital accreditation
  • Laparoscopy
  • Laparotomy
  • National Health Insurance Research Database
  • Salpingectomy
  • Salpingostomy
  • Salpingotomy

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

Primary and Repeated Surgeries for Ectopic Pregnancies and Distribution by Patient Age, Surgeon Age, and Hospital Levels : An 11-Year Nationwide Population-Based Descriptive Study in Taiwan. / Hsu, Ming I.; Tang, Chao Hsiun; Hsu, Pei Yang; Huang, Yu Tung; Long, Cheng Yu; Huang, Kuan Hui; Wu, Ming-Ping.

In: Journal of Minimally Invasive Gynecology, Vol. 19, No. 5, 09.2012, p. 598-605.

Research output: Contribution to journalArticle

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abstract = "Study Objective: To describe the changing trend, repeat operation rate, and distribution of laparoscopy, as compared with laparotomy, in treating ectopic pregnancy, according to patient age, preoperative conditions, surgeon age, and hospital accreditation level, in Taiwan over 11-years. Design: Retrospective cohort study (Canadian Task Force classification II-2). Setting: Population-based nationwide insurance database. Patients: Women who underwent either laparotomy or laparoscopy because of ectopic pregnancy. Interventions: Women who had National Health Insurance (NHI) underwent various surgical procedures to treat ectopic pregnancy. Data for this study were obtained from the Inpatient Expenditures by Admissions files of the NHI Research Database, released by the NHI program in Taiwan between 1997 and 2007. Measurements and Main Results: A total of 43 170 women with 44 928 operations were identified. Only the primary surgeries, via either laparotomy or laparoscopy, performed because of ectopic pregnancy were included for analysis. The annual number of procedures to treat ectopic pregnancies decreased in the later years of the 11-year study. Laparotomy decreased significantly, from 81.2{\%} in 1997 to 26.2{\%} in 2007, whereas laparoscopic procedures increased significantly, from 18.8{\%} in 1997 to 73.8{\%} in 2007, as evidenced at log-linear regression analysis (p <.001). The rate of repeat operations because of persistent ectopic pregnancy was higher in the laparoscopy group than in the laparotomy group (0.38{\%} vs 0.14 {\%}; p <.001). Patients were more likely to undergo the same type of operation for the repeated surgery (i.e., laparotomy to laparotomy in 73.1{\%} or laparoscopy to laparoscopy in 80.2{\%}; p = 0.43). Use of laparoscopy (58.1{\%}) and laparotomy (41.9{\%}) differed according to patient age, preoperative comorbidities, surgeon age, and hospital accreditation level and ownership type. With older patients, those with preoperative anemia or shock, and elder surgeons, there was a greater chance that laparotomy would be performed. The probability of undergoing laparotomy was greater in patients in regional hospitals, local hospitals, and office-based clinics compared with those in medical centers. Conclusions: There has been considerable change in the type of surgical approach used to treat ectopic pregnancy in Taiwan over the past 11 years. Laparoscopy is preferred to laparotomy, and has become the standard surgical approach to treating ectopic pregnancies in Taiwan. However, laparoscopy is associated with a higher rate of repeat operations. The laparoscopic approach signifies a profound change in treating ectopic pregnancies among patients, surgeons, and hospital types.",
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AU - Tang, Chao Hsiun

AU - Hsu, Pei Yang

AU - Huang, Yu Tung

AU - Long, Cheng Yu

AU - Huang, Kuan Hui

AU - Wu, Ming-Ping

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N2 - Study Objective: To describe the changing trend, repeat operation rate, and distribution of laparoscopy, as compared with laparotomy, in treating ectopic pregnancy, according to patient age, preoperative conditions, surgeon age, and hospital accreditation level, in Taiwan over 11-years. Design: Retrospective cohort study (Canadian Task Force classification II-2). Setting: Population-based nationwide insurance database. Patients: Women who underwent either laparotomy or laparoscopy because of ectopic pregnancy. Interventions: Women who had National Health Insurance (NHI) underwent various surgical procedures to treat ectopic pregnancy. Data for this study were obtained from the Inpatient Expenditures by Admissions files of the NHI Research Database, released by the NHI program in Taiwan between 1997 and 2007. Measurements and Main Results: A total of 43 170 women with 44 928 operations were identified. Only the primary surgeries, via either laparotomy or laparoscopy, performed because of ectopic pregnancy were included for analysis. The annual number of procedures to treat ectopic pregnancies decreased in the later years of the 11-year study. Laparotomy decreased significantly, from 81.2% in 1997 to 26.2% in 2007, whereas laparoscopic procedures increased significantly, from 18.8% in 1997 to 73.8% in 2007, as evidenced at log-linear regression analysis (p <.001). The rate of repeat operations because of persistent ectopic pregnancy was higher in the laparoscopy group than in the laparotomy group (0.38% vs 0.14 %; p <.001). Patients were more likely to undergo the same type of operation for the repeated surgery (i.e., laparotomy to laparotomy in 73.1% or laparoscopy to laparoscopy in 80.2%; p = 0.43). Use of laparoscopy (58.1%) and laparotomy (41.9%) differed according to patient age, preoperative comorbidities, surgeon age, and hospital accreditation level and ownership type. With older patients, those with preoperative anemia or shock, and elder surgeons, there was a greater chance that laparotomy would be performed. The probability of undergoing laparotomy was greater in patients in regional hospitals, local hospitals, and office-based clinics compared with those in medical centers. Conclusions: There has been considerable change in the type of surgical approach used to treat ectopic pregnancy in Taiwan over the past 11 years. Laparoscopy is preferred to laparotomy, and has become the standard surgical approach to treating ectopic pregnancies in Taiwan. However, laparoscopy is associated with a higher rate of repeat operations. The laparoscopic approach signifies a profound change in treating ectopic pregnancies among patients, surgeons, and hospital types.

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KW - Anemia

KW - Ectopic pregnancy

KW - Hemorrhagic shock

KW - Hospital accreditation

KW - Laparoscopy

KW - Laparotomy

KW - National Health Insurance Research Database

KW - Salpingectomy

KW - Salpingostomy

KW - Salpingotomy

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