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Changes in Hysterectomy Trends After the Implementation of a Clinical Pathway
Amin Sanei-Moghaddam1, Tianzhou Ma, Sharon L Goughnour
1Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Women's Research Institute, University of Pittsburgh School of Medicine, the Departments of Biostatistics and Epidemiology, University of Pittsburgh Graduate School of Public Health, and the Payer Provider Programs and the Divisions of Gynecologic Oncology and Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology, and Reproductive Services, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Insights
Implementing a hysterectomy pathway significantly reduced the rate of total abdominal hysterectomy (TAH) procedures. This surgical pathway led to a decrease in TAH from 27.8% in 2012 to 17% in 2014.
Area of Science:
- Gynecology
- Surgical Innovation
- Healthcare Management
Background:
- Total abdominal hysterectomy (TAH) has been a traditional surgical approach for hysterectomy.
- Minimally invasive hysterectomy techniques offer potential benefits such as reduced recovery time and complications.
- Standardizing surgical procedures through pathways can improve patient outcomes and resource utilization.
Purpose of the Study:
- To evaluate the impact of a standardized hysterectomy pathway on the utilization of total abdominal hysterectomy (TAH) procedures.
- To assess changes in the proportion of TAH versus minimally invasive hysterectomy over a defined period.
- To determine the effectiveness of pathway implementation in reducing TAH rates for benign indications.
Main Methods:
- Retrospective review of medical records for hysterectomy surgeries performed for benign indications.
- Data collection from University of Pittsburgh Medical Center hospitals between fiscal years 2012 and 2014.
- Analysis of surgical approach (TAH vs. minimally invasive), patient age, and indication, with trend analysis using Cochran-Armitage test.
Main Results:
- A total of 6,544 hysterectomies were analyzed.
- The proportion of TAH procedures decreased significantly from 27.8% in FY 2012 to 17% in FY 2014 (P < .001).
- This decreasing trend in TAH persisted even after adjusting for surgical indication.
Conclusions:
- Implementation of a hysterectomy pathway is associated with a significant reduction in the proportion of total abdominal hysterectomy (TAH) procedures.
- The pathway appears effective in promoting the adoption of less invasive surgical approaches.
- Further research may explore long-term patient outcomes associated with this pathway.
Objective:
To investigate the effect of hysterectomy pathway implementation on the proportion of total abdominal hysterectomy (TAH) procedures performed between fiscal years 2012 and 2014.
Methods:
We conducted a retrospective medical record review. All hysterectomy surgeries performed for benign indications at University of Pittsburgh Medical Center hospitals from fiscal year 2012 to fiscal year 2014 were identified through various systems including Medipac and EpicCare. We analyzed the cases by surgical approach (TAH compared with minimally invasive hysterectomy), age, and indication of surgery. Changes over time were analyzed using Cochran-Armitage test for linear trends.
Results:
A total number of 6,544 patients were included in this study. The mean age of the participants was 48.6 years (standard deviation 11.69). In fiscal year 2012, of 1,934 hysterectomies performed as a result of noncancerous conditions, 538 were TAH procedures (27.8%). However, this number declined in fiscal year 2013 to 22% (485 TAH procedures of 2,186 hysterectomies) and further declined in fiscal year 2014 to 17% (413 TAH surgeries of 2,424 hysterectomies). Overall, there was a significant reduction in the proportion of TAH procedures, from 27.8% in fiscal year 2012 to 17% in fiscal year 2014 (P for trend <.001). After adjusting for surgery indication, the decreasing trend of TAH procedures still persisted (P for trend <.001).
Conclusion:
Implementation of a hysterectomy pathway has been associated with a decrease in the proportion of TAH hysterectomy procedures.
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