Transactions of the Twenty-Eighth Scientific Meeting of the Society of Gynecological Surgeons
Guidelines for the selection of the route of hysterectomy: Application in a resident clinic population

Presented at the Twenty-eighth Annual Meeting of the Society of Gynecologic Surgeons, Dallas, Tex, March 4-6, 2002.
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Abstract

Objective: The purpose of this study was to evaluate the effectiveness of the Society of Pelvic Reconstructive Surgeons guidelines for the determination of the route of hysterectomy in a resident clinic population. Study design: A total of 407 consecutive women from the resident clinic population at Wright State University between October 1, 1994, and December 31, 1999, were assigned prospectively to abdominal or vaginal hysterectomy groups according to Society of Pelvic Reconstructive Surgeons guidelines. The women's age, race, and preoperative and postoperative uterine weights, length of stay, laparoscopic scores, operative time, and complications were compared. Results: Vaginal hysterectomy was completed successfully in 91.8% of the women. As expected, vaginal hysterectomy required the shortest operative time and length of stay and was associated with fewer complications than the abdominal approach (P <.01). Laparoscopic assistance was necessary in 25.8% of patients to assess extrauterine disease. Conclusion: Resident physicians who followed the practice guidelines reduced the ratio of abdominal-to-vaginal hysterectomy from 3:1 to 1:11. The application of practice guidelines for the selection of the route of hysterectomy can increase the ratio of vaginal hysterectomies that are performed in residency programs and can help eradicate inconsistencies in health care delivery that exist currently. (Am J Obstet Gynecol 2002;187:1521-7.)

Section snippets

Methods

Data were collected from the charts of 407 women from the resident clinic population who had consecutive hysterectomies at Wright State University between 1994 and 1999. The resident staff, in consultation with the gynecologic faculty, was responsible for the selection of the route of hysterectomy according to the SPRS guidelines. Thirty fourth-year resident physicians performed all hysterectomies during this period, with the technical assistance of 7 faculty gynecologic surgeons with different

Results

In the 407 consecutive women in whom the route of hysterectomy was selected by resident physicians according to the SPRS guidelines, the ratio of abdominal-to-vaginal hysterectomy decreased from 3:1 in the 1989 to 1993 study period to 1:11 in the 1994 to 1999 study period. This ratio was compared with other residency programs in the United States and Canada, which reported a 3:1 ratio of abdominal-to-vaginal hysterectomy.

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Comment

Considerable variation has been observed in the health care services for hysterectomy from community to community, physician to physician, and residency programs. Practice parameters have been developed for many conditions as a tool to help physicians practice more effectively; the American Medical Association launched a drive to support practice guideline development. Parameters that were developed by physician organizations (such as the SPRS) survey the scientific research and other sources

Acknowledgements

We thank Manling Chen from the Statistical Consulting Center, Wright State University, for providing the statistical analyses.

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