Hysterectomy rate changes correspond with start of COVID-19 pandemic

The rate of hysterectomy was lower in 2020 compared with 2019, with the greatest decrease corresponding with the beginning of the COVID-19 pandemic from March to May, according to findings published in Obstetrics & Gynecology.

“As the pandemic evolved, many people delayed or avoided non-COVID-19-related health care due to both fear of exposure to COVID-19 and the reduced availability of resources for medical care for non-COVID-19-related conditions,” Jordan Emont, MD, MPH, an OB/GYN resident at NewYork-Presbyterian Hospital, and colleagues wrote. “To date, there have been limited data describing the effect of the COVID-19 pandemic on the utilization of gynecologic services, including surgery.”

Emont and colleagues identified hysterectomies recorded in the National Inpatient Sample and the National Ambulatory Surgery Sample from 2019 to 2020. They also identified indicators for hysterectomy, which included cancers, preinvasive diseases and benign diseases.

The primary outcome was month-to-month trends in and total number of hysterectomies.

There were more than 1 million hysterectomies performed from 2019 to 2020, 548,802 (53.4%) of which occurred in 2019 and 480,990 (46.7%) of which were performed in 2020. The largest proportion of hysterectomies were performed laparoscopically (70.2%) and for benign pathology (77.1%) in patients aged 40 to 49 years (38.2%) who were white (63.9%).

In 2019, the number of cases increased throughout the year, such that there were 39,998 hysterectomies in January and 48,607 hysterectomies in December. There was a significant increase in the number of hysterectomies between January 2019 to January 2020 (average monthly percent change [AMPC] = 1.5%; 95% CI, 0.6-2.5).

However, there was a sharp decline in hysterectomies from January to April 2020 (40,240 vs. 10,566; AMPC = –29.2%; 95% CI, –39.8 to –16.8). There was then an increase to 40,023 hysterectomies in July (AMPC = 39.4%; 95% CI, 18.6-63.9). This remained stable through the end of the year.

Comparisons between 2019 and 2020 revealed that the rate of hysterectomy decreased year over year for March (–24%), April (–74.2%) and May (–35.1%). Hysterectomy rates then stabilized and increased such that the rate was 7.1% higher in September 2020 vs. 2019. The rate decreased by 9.9% in October 2020 vs. 2019.

Between March and June 2020, patients who underwent hysterectomy were most likely to have cancer, older age and medical comorbidities (all P < .05).

Of note, the findings were limited by the unavailability of data on the reasons procedures were deferred and whether other treatments were offered.

“The COVID-19 pandemic led to unprecedented changes in the allocation of gynecologic care,” Emont and colleagues wrote. “Further data are clearly needed to determine the long-term effects of delays in care encountered by patients in 2020.”