Evaluation of Swiss guidelines for the indication for hysterectomy in relation to patient outcome

BACKGROUND

The application of national guidelines which specify the appropriateness for hysterectomy is believed to lead to improved patient outcomes. However, there was no evidence to support this assumption by outcome data.

GOALS

To evaluate adherence to guidelines and the validity of the 1997 Swiss guidelines for the appropriateness of hysterectomy based on changes in patients' functional and psychosocial status.

METHOD

Multicentre study of 370 consecutive cases from 18 public hospitals assessing data on appropriateness and changes in patient status following hysterectomy. Data on appropriateness were obtained before the procedure (n = 286). Changes in patient status following hysterectomy were assessed using an adapted and weighted score. Baseline data were collected up to 8 weeks prior to hysterectomy. Outcome data were obtained 16-32 weeks after surgery (n = 237). Patients for whom appropriateness data were available (n = 286) were categorized into three groups: (1) 214 patients (74.82%) with an indication for hysterectomy, (2) 36 patients (12.58%) classified as having an indication with regard to their preference, and (3) 36 patients (12.58%) classified as not being appropriate for surgery according to national guidelines.

RESULTS

In 87% the indication for hysterectomy was judged as appropriate according to the guidelines. The status of all three groups of patients after hysterectomy was found to be significantly improved compared to baseline levels. Patients with an appropriate indication tended to profit more from hysterectomy.

CONCLUSION

The appropriateness rating found may be interpreted as an example of justified use of medical procedural intervention. There was a positive correlation between appropriateness and outcome. The 1997 guidelines still seem to be valid.

[Practice guidelines: conservative treatment of fibroids]

The conservative treatment of uterine fibroids is essentially based on symptomatology and patient's choice of treatment. The gynaecologist must develop a clear therapeutic protocol based on clinical examination, available test results and consideration of patient preference. The therapeutic options include close surveillance, hormonal treatments, conservative operative endoscopy and arterial embolization.