Decision-directed hysterectomy: a possible approach to improve medical andeconomic outcomes

Objective: This study was undertaken to determine if the use of formal guid elines in selecting the route of hysterectomy would improve medical and eco nomic outcomes. Method: Data from 4595 hysterectomies performed at a single center in women whose primary diagnosis were unrelated to invasive cancer or pregnancy were analyzed in terms of mean, uterine weight, costs, length of stay, and complications. Results: When formal guidelines were used to de termine the route of hysterectomy, vaginal hysterectomy was performed in 90 % of the patients treated and in 100% of the patients in whom the pathology was confined to the uterus. In comparison, when formal guidelines were not incorporated in the decision-making process, vaginal hysterectomy was perf ormed in 42% of the patients treated and in 64% of the patients in whom the pathology was confined to the uterus. Conclusions: Using these or similar guidelines to assist in clinical decision making would have resulted in a p otential savings of US$1184000 for every 1000 hysterectomies performed at t he institution where this study was undertaken and would have freed up 1020 patient-bed days and reduced complications by approximately 20%. (C) 2000 International Federation of Gynecology and Obstetrics AII rights reserved.