alexa Abdominal versus vaginal hysterectomy: a statistical model for determining physician decision making and patient outcome.
Reproductive Medicine

Reproductive Medicine

Gynecology & Obstetrics

Author(s): Kovac SR, Christie SJ, Bindbeutel GA

Abstract Share this page

Abstract To identify the effects of preoperative assessment and physician practice style on the outcomes of hysterectomy, the authors conducted a small-area analysis of 640 women under-going abdominal or vaginal hysterectomy in a St. Louis, Missouri, hospital. Of these patients, excluding outliers, 115 met the conditions for inclusion in the study. Hysterectomies were performed by the abdominal route in 55 (47.8\%) and by the vaginal route in 60 (52.2\%) of the 115 patients. A total of 29 physicians performed the hysterectomies. Of these 29, 15 (51.7\%) were predisposed toward the abdominal approach, 13 (44.8\%) had no appreciable predisposition, and one (3.5\%) was predisposed toward the vaginal procedure. Path analysis revealed that physician decision making about the type of hysterectomy procedure performed was primarily influenced by practice style (predisposition) and variables related to physician preoperative assessments (uterine size and uterine mobility), some of which are prone to inaccuracy. Factors that traditionally determine operative approach (such as obesity) did not always act in the expected direction. Furthermore, the decision to perform hysterectomy vaginally had positive outcomes for both cost and length of hospital stay. Shorter hospital stays were associated with physician factors that included selection of the vaginal route, training site, predisposition toward the vaginal procedure, and preoperative assessment of uterine size. Length of hospital stay and duration of surgery were the strongest predictors of cost. Other factors being equal, the mean cost of a vaginal procedure is $224 less than that of an abdominal hysterectomy. Establishing the vaginal approach as the recommended procedure for this specific population should result in cost reductions and shorter hospital stays without negatively impacting quality of care.
This article was published in Med Decis Making and referenced in Gynecology & Obstetrics

Relevant Expert PPTs

Relevant Speaker PPTs

Recommended Conferences

Relevant Topics

Peer Reviewed Journals
 
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2017-18
 
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri, Food, Aqua and Veterinary Science Journals

Dr. Krish

[email protected]

1-702-714-7001 Extn: 9040

Clinical and Biochemistry Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Business & Management Journals

Ronald

[email protected]

1-702-714-7001Extn: 9042

Chemical Engineering and Chemistry Journals

Gabriel Shaw

[email protected]

1-702-714-7001 Extn: 9040

Earth & Environmental Sciences

Katie Wilson

[email protected]

1-702-714-7001Extn: 9042

Engineering Journals

James Franklin

[email protected]

1-702-714-7001Extn: 9042

General Science and Health care Journals

Andrea Jason

[email protected]

1-702-714-7001Extn: 9043

Genetics and Molecular Biology Journals

Anna Melissa

[email protected]

1-702-714-7001 Extn: 9006

Immunology & Microbiology Journals

David Gorantl

[email protected]

1-702-714-7001Extn: 9014

Informatics Journals

Stephanie Skinner

[email protected]

1-702-714-7001Extn: 9039

Material Sciences Journals

Rachle Green

[email protected]

1-702-714-7001Extn: 9039

Mathematics and Physics Journals

Jim Willison

[email protected]

1-702-714-7001 Extn: 9042

Medical Journals

Nimmi Anna

[email protected]

1-702-714-7001 Extn: 9038

Neuroscience & Psychology Journals

Nathan T

[email protected]

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

John Behannon

[email protected]

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

[email protected]

1-702-714-7001 Extn: 9042

 
© 2008-2017 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version
adwords