Decision‐directed hysterectomy: a possible approach to improve medical and economic outcomes

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Abstract
Objective: This study was undertaken to determine if the use of formal guidelines in selecting the route of hysterectomy would improve medical and economic 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 determine 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 performed 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 potential savings of US$1 184 000 for every 1000 hysterectomies performed at the institution where this study was undertaken and would have freed up 1020 patient‐bed days and reduced complications by approximately 20%.