Snapshots

Age, race, region and insurance status play a large role in the type of hysterectomy that women receive. Researchers used records from the 2005 Nationwide Inpatient Sample, which collects patient discharge data from approximately 90% of U.S. hospitals, to determine rates of laparoscopic vs. vaginal and abdominal hysterectomy. Laparoscopic techniques are more expensive than abdominal hysterectomies, but offer faster recovery, less blood loss, fewer infections, and require shorter hospital stays. Women who lacked private health insurance were less likely to have laparoscopic hysterectomy. Medicaid and Medicare provide $100-$200 less in reimbursement for these procedures, which provides a disincentive to use laparoscopy on publicly insured patients. Even when taking clinical diagnosis into account (i.e., fibroids, pelvic infection, uterine prolapse), women of color had 40-50% lower chance of having a laparoscopic hysterectomy than abdominal hysterectomy. Women over age 35 also had lower rates of laparoscopic hysterectomy, with women over 55 being 62% less likely to undergo a laparoscopic procedure.

Jacoby VL, Autry A, Jacobson G et al., “Nationwide Use of Laparoscopic Hysterectomy Compared With Abdominal and Vaginal Approaches,” Obstetrics & Gynecology 2009; November 2009:1041-1048.

Swedish researchers report that women who receive only one embryo during in-vitro fertilization (IVF) are just as likely to conceive and give birth as those who receive two embryos (44% vs. 51%, respectively). Over one-quarter (27.5%) of women receiving two embryos had a multiple birth, however, compared to just 2.3% of women who received just one embryo. Multiple births increase the risks of adverse outcomes such as low birth weight and its attendant complications. Women implanted with two embryos were also more likely to have babies born before 37-weeks gestation compared to women implanted with one embryo (25.5% vs. 11.8%). Researchers followed 661 women’s medical records for up to four cycles of IVF in which the first implantation used a fresh embryo and the other three used frozen embryos.

Thurin-Kjellberg A, Olivius C, Bergh C, “Cumulative Live-Birth Rates in a Trial of Single-Embryo or Double-Embryo Transfer,” New England Journal of Medicine 2009; Oct. 29, 2009 :1812-1813.

A new study of Danish women found that chronic post-operative pain is a common problem among those who have breast cancer surgery. Researchers sent a questionnaire to 3,754 women aged 18-70 who had had a mastectomy or breast-conserving surgery (and chemotherapy or radiotherapy) for breast cancer between January 1, 2005 and December 31, 2006. The response rate was 87%. Two to three years after breast cancer treatment, 47% of women reported experiencing persistent pain in one or more area: 13% experienced severe pain, 39% reported moderate pain, and 48% had light pain. The breast area was the most frequent site of pain (86%), followed by the armpit (63%), arm (57%), and side of the body (56%). Younger age (18-39 years) was the most important determinant of persistent pain, particularly amongst those who had breast-conserving surgery. Among women who had mastectomies, those aged 40-49 reported the most pain.

Gärtner R, Jensen MB, Nielsen J, et al., “Prevalence of and factors associated with persistent pain following breast cancer surgery,” Journal of the American Medical Association 2009; 302(18):1985-92.