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Rajadurai VA, Nathan E, Pontré JC, Mcelhinney B, Karthigasu KA, Hart R. The effect of obesity on cost of total laparoscopic hysterectomy. Aust N Z J Obstet Gynaecol 2022; 62:566-573. [DOI: 10.1111/ajo.13520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 03/02/2022] [Accepted: 03/14/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Vinita Angeline Rajadurai
- Department of Obstetrics and Gynaecology King Edward Memorial Hospital for Women Perth Western Australia Australia
| | - Elizabeth Nathan
- Division of Obstetrics and Gynaecology University of Western Australia Perth Western Australia Australia
- Women and Infants Research Foundation King Edward Memorial Hospital Perth Western Australia Australia
| | - Jennifer Claire Pontré
- Department of Gynaecology King Edward Memorial Hospital Perth Western Australia Australia
| | - Bernadette Mcelhinney
- Department of Gynaecology King Edward Memorial Hospital Perth Western Australia Australia
| | | | - Roger Hart
- Department of Obstetrics and Gynaecology King Edward Memorial Hospital for Women Perth Western Australia Australia
- Division of Obstetrics and Gynaecology University of Western Australia Perth Western Australia Australia
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Gutman RE, Morgan D, Levy B, Kho RM, Walter AJ, Mansuria S. How Can We Increase the Percentage and Quality of Minimally Invasive Hysterectomy for Benign Disease Among Low/Intermediate-Volume Gynecologic Surgeons? A Perspective Piece From an Expert Panel Session at the 2017 Society of Gynecologic Surgeons Annual Meeting. J Minim Invasive Gynecol 2017; 24:1055-1059. [PMID: 28576694 DOI: 10.1016/j.jmig.2017.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Robert E Gutman
- MedStar Washington Hospital Center, Georgetown University, Washington, DC.
| | | | - Barbara Levy
- American Congress of Obstetricians and Gynecologists, Washington, DC
| | | | | | - Suketu Mansuria
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Linkov F, Sanei-Moghaddam A, Edwards RP, Lounder PJ, Ismail N, Goughnour SL, Kang C, Mansuria SM, Comerci JT. Implementation of Hysterectomy Pathway: Impact on Complications. Womens Health Issues 2017; 27:493-498. [PMID: 28347618 DOI: 10.1016/j.whi.2017.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 02/06/2017] [Accepted: 02/08/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Hysterectomy is one of the most common surgical procedures in the United States. For women who need hysterectomy, it is important to ensure that minimally invasive hysterectomy procedures are used appropriately to reduce surgical complications and improve value of care. Although we previously demonstrated a reduction in total abdominal hysterectomy rates after the implementation of hysterectomy pathway treatment algorithm in 2012, this study focuses on exploring the effect of pathways implementation on surgical outcomes. METHODS All retrospective medical records for hysterectomy surgeries performed for benign indications at University of Pittsburgh Medical Center hospitals between the fiscal years (FY) 2012 and 2014 were identified. We analyzed the health care outcomes by route of surgery and year using Χ2 test for categorical data, and non-parametric approaches for non-normal continuous variables. RESULTS A total of 6,569 hysterectomies for benign indications were performed between FY 2012 and 2014. In FY 2012, 1,154 patients (59.15%) had a length of stay of 1 day or less, whereas in FY 2014 this number increased to 1,791 (74.53%; p < .0001). Within 3 years of implementing the pathway, surgical site infections had a reduction of 47%, with a considerable trend toward significance (p = .067). CONCLUSIONS Implementation of hysterectomy pathway has been associated with reduction of surgical complications in benign hysterectomy settings. Implementation of clinical pathways offers an opportunity for improving patient outcomes that should be investigated in various health care settings and across procedures.
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Affiliation(s)
- Faina Linkov
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Amin Sanei-Moghaddam
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert P Edwards
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Magee-Womens Hospital, Pittsburgh, Pennsylvania
| | - Paula J Lounder
- Payer Provider Programs, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Naveed Ismail
- Payer Provider Programs, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sharon L Goughnour
- Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Chaeryon Kang
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Suketu M Mansuria
- Divisions of Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Magee-Womens Hospital, Pittsburgh, Pennsylvania
| | - John T Comerci
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Magee-Womens Hospital, Pittsburgh, Pennsylvania
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Heaton RL, Walid MS. An intention-to-treat study of total laparoscopic hysterectomy. Int J Gynaecol Obstet 2016; 111:57-61. [DOI: 10.1016/j.ijgo.2010.04.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 04/21/2010] [Accepted: 04/26/2010] [Indexed: 11/28/2022]
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Driessen SR, Van Zwet EW, Haazebroek P, Sandberg EM, Blikkendaal MD, Twijnstra AR, Jansen FW. A dynamic quality assessment tool for laparoscopic hysterectomy to measure surgical outcomes. Am J Obstet Gynecol 2016; 215:754.e1-754.e8. [PMID: 27402052 DOI: 10.1016/j.ajog.2016.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/28/2016] [Accepted: 07/01/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND The current health care system has an urgent need for tools to measure quality. A wide range of quality indicators have been developed in an attempt to differentiate between high-quality and low-quality health care processes. However, one of the main issues of currently used indicators is the lack of case-mix correction and improvement possibilities. Case-mix is defined as specific (patient) characteristics that are known to potentially affect (surgical) outcome. If these characteristics are not taken into consideration, comparisons of outcome among health care providers may not be valid. OBJECTIVE The objective of the study was to develop and test a quality assessment tool for laparoscopic hysterectomy, which can serve as a new outcome quality indicator. STUDY DESIGN This is a prospective, international, multicenter implementation study. A web-based application was developed with 3 main goals: (1) to measure the surgeon's performance using 3 primary outcomes (blood loss, operative time, and complications); (2) to provide immediate individual feedback using cumulative observed-minus-expected graphs; and (3) to detect consistently suboptimal performance after correcting for case-mix characteristics. All gynecologists who perform laparoscopic hysterectomies were requested to register their procedures in the application. A patient safety risk factor checklist was used by the surgeon for reflection. Thereafter a prospective implementation study was performed, and the application was tested using a survey that included the System Usability Scale. RESULTS A total of 2066 laparoscopic hysterectomies were registered by 81 gynecologists. Mean operative time was 100 ± 39 minutes, blood loss 127 ± 163 mL, and the complication rate 6.1%. The overall survey response rate was 75%, and the mean System Usability Scale was 76.5 ± 13.6, which indicates that the application was good to excellent. The majority of surgeons reported that the application made them more aware of their performance, the outcomes, and patient safety, and they noted that the application provided motivation for improving future performance. CONCLUSION We report the development and test of a real-time, dynamic, quality assessment tool for measuring individual surgical outcome for laparoscopic hysterectomy. Importantly, this tool provides opportunities for improving surgical performance. Our study provides a foundation for helping clinicians develop evidence-based quality indicators for other surgical procedures.
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Abstract
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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Siedhoff MT, Carey ET, Findley AD, Riggins LE, Garrett JM, Steege JF. Effect of Extreme Obesity on Outcomes in Laparoscopic Hysterectomy. J Minim Invasive Gynecol 2012; 19:701-7. [DOI: 10.1016/j.jmig.2012.07.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 07/04/2012] [Accepted: 07/12/2012] [Indexed: 11/16/2022]
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Jahan S, Das T, Mahmud N, Khan MI, Akter L, Mondol SK, Yasmin S, Nahar N, Habib SH, Saha S, Paul D, Joarder M. A Comparative Study Between Laparoscopically Assisted Vaginal Hysterectomy and Vaginal Hysterectomy: Experience in a Tertiary Diabetes Care Hospital in Bangladesh. JOURNAL OF GYNECOLOGICAL ENDOSCOPY AND SURGERY 2011; 2:79-84. [PMID: 26085749 PMCID: PMC4453205 DOI: 10.4103/0974-1216.114078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The study was undertaken to compare the efficiency and outcome of Laparoscopic Assisted Vaginal Hysterectomy (LAVH) and Vaginal Hysterectomy (VH) in terms of operative time, cost, estimated blood loss, hospital stay, quantity of analgesia use, intra- and postoperative complication rates and patients recovery. MATERIALS AND METHODS A total of 500 diabetic patients were prospectively collected in the study period from January 2005 through January 2009. The performance of LAVH was compared with that of VH, in a tertiary care hospital. The procedures were performed by the same surgeon. RESULTS There was no significant difference in terms of age, parity, body weight or uterine weight. The mean estimated blood loss in LAVH was significantly lower when compared with the VH group (126.5±39.8 ml and 100±32.8 ml), respectively. As to postoperative pain, less diclofenac was required in the LAVH group compared to the VH group (70.38±13.45 mg and 75.18±16.45 mg), respectively. CONCLUSIONS LAVH, is clinically and economically comparable to VH, with patient benefits of less estimated blood loss, lower quantity of analgesia use, lower rate of intra- and postoperative complications, less postoperative pain, rapid patient recovery, and shorter hospital stay.
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Affiliation(s)
- Samsad Jahan
- Department of Gynecology and Obstetrics, BIRDEM, Dhaka, Bangladesh
| | | | - Nusrat Mahmud
- Department of Gynecology and Obstetrics, BIRDEM, Dhaka, Bangladesh
| | | | - Latifa Akter
- Department of Gynecology and Obstetrics, BIRDEM, Dhaka, Bangladesh
| | | | - Sharmin Yasmin
- Department of Gynecology and Obstetrics, BIHS, Dhaka, Bangladesh
| | - Nurun Nahar
- Department of Gynecology and Obstetrics, SSMC, Dhaka, Bangladesh
| | | | - Soma Saha
- Health Economics Unit, BADAS, Dhaka, Bangladesh
| | | | - Mahjabin Joarder
- Department of Gynecology and Obstetrics, Bangladesh Medical College, Dhaka, Bangladesh
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Chen B, Hu S, Wang L, Wang K, Zhang G, Zhang H, Wachtel MS, Frezza EE. Economical Strategies of Laparoscopic Splenectomy: A Chinese Single-Center Experience. Visc Med 2007. [DOI: 10.1159/000101456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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