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The Quality Gap1
600,000 hysterectomies are performed in the U.S. each year, 60-70% of them done through abdominal surgery. Gynecologic surgeons recommend that for benign conditions, minimally invasive surgery (vaginal, laparoscopically assisted vaginal or laparoscopic) is the approach of choice.
A Cochrane study of hysterectomy route found that minimally invasive surgeries have:
- Lower rates of infection
- Shorter hospital stays
- Lower rates of complications
- Less major bleeding
What is the quality improvement opportunity? In one study, physicians were asked to use specific criteria to determine what approach to apply to hysterectomy. Physicians who used formal guidelines to determine the route of hysterectomy performed a vaginal hysterectomy on 90% of the patients treated (Kovac,SR, 2000). Without the specific decision criteria, physicians carry out a vaginal hysterectomy in 42% of the patients treated. This means that physicians are performing abdominal hysterectomies for a very large percentage of patients for whom a less invasive approach would be clinically appropriate.
Physician treatment decisions have implications for cost and quality of life. The 2000 Kovac study concluded that if physicians used treatment guidelines to assist decisions about route of hysterectomy, they would generate a potential savings of US $1184000 for every 1000 hysterectomies, would have freed up 1020 patient-bed days and reduced complications by approximately 20%.
1 Statistics and information cited on this web page can be found in the research articles and other publication cited here
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