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Vaginal Hysterectomy in a Large Health Maintenance Organization: Retrospective Application of a Clinical Algorithm
Kristen Buono1, Emily Adams-Piper1, Kimaya Gokhale1
1Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Southern California Permanente Medical Group, Irvine Medical Center, Irvine (Drs. Buono, Adams-Piper, Guaderrama and Whitcomb and Ms. Gokhale); Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange (Dr. Buono); Divsion of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, The Permanente Medical Group, San Jose Medical Center, San Jose (Dr. Adams-Piper); Department of Research and Evaluation, Southern California Permanente Medical Group, Pasadena (Mrs. Li).
Vaginal hysterectomy (VH) rates were lower than expected, with surgeon experience influencing decisions. Patients not meeting the VH algorithm but undergoing the procedure had similar outcomes, suggesting algorithm refinement is needed.
Area of Science:
- Gynecology
- Surgical Outcomes
- Health Services Research
Background:
- Benign hysterectomy is a common gynecologic procedure.
- Vaginal hysterectomy (VH) is associated with certain patient characteristics and potentially better outcomes.
- Understanding practice patterns is crucial for optimizing surgical care.
Purpose of the Study:
- To describe benign hysterectomy practice patterns in a large health maintenance organization (HMO).
- To identify clinical and surgeon characteristics associated with performing VH.
- To evaluate adherence to a VH algorithm and compare perioperative outcomes.
Main Methods:
- Retrospective cohort study of women undergoing benign hysterectomy within a community HMO.
- Analysis of patient demographics, surgeon characteristics, route of hysterectomy, and perioperative complications.
- Application of a VH algorithm to assess practice conformity and compare outcomes.
Main Results:
- Only 13.3% of benign hysterectomies were performed vaginally.
- Factors associated with VH included prior vaginal delivery, Hispanic ethnicity, normal uterine size, and uterine descent.
- High-volume surgeons and those with longer practice durations were more likely to perform VH.
Conclusions:
- A significant proportion of patients suitable for VH underwent non-vaginal hysterectomy, experiencing longer operative times and more complications.
- Surgeon characteristics, such as volume and experience, may contribute to this practice gap.
- Current VH algorithms may require refinement to better reflect clinical practice and improve patient outcomes.
