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Perm J. 2015 Fall;19(4):39-45. doi: 10.7812/TPP/15-023. Epub 2015 Jul 24.

Safely Increase the Minimally Invasive Hysterectomy Rate: A Novel Three-Tiered Preoperative Categorization System Can Predict the Difficulty for Benign Disease.

Author information

1
Obstetrician/Gynecologist at the Fontana Medical Center in CA. esteban.a.andryjowicz@kp.org.
2
Former Regional Chief of Obstetrics and Gynecology for the Southern California Permanente Medical Group at the Fontana Medical Center in CA and the present Chief of Obstetrics and Gynecology at the Fontana Medical Center in CA. teresa.b.wray@kp.org.
3
Obstetrician/Gynecologist at the Fontana Medical Center in CA. reinaldo.v.ruiz@kp.org.
4
Obstetrician/Gynecologist at the Fontana Medical Center in CA. james.d.rudolf@kp.org.
5
Obstetrician/Gynecologist at the Fontana Medical Center in CA. sara.x.noroozkhani@kp.org.
6
Obstetrician/Gynecologist at the Fontana Medical Center in CA. sandra.c.crowder@kp.org.
7
Research Manager of Biostatistics for the Southern California Permanente Medical Group in Pasadena. jeff.m.slezak@kp.org.

Abstract

CONTEXT:

A nonlaparotomic route is recommended for hysterectomy for benign indications.

OBJECTIVE:

1) Predict the difficulty of hysterectomy to treat benign disease as measured by operative time and risk of laparotomy, 2) confirm the safety and quality of increasing our minimally invasive hysterectomy (MIH) rate, and 3) determine whether the assistant's experience affected the likelihood of an MIH being performed in equally difficult hysterectomies.

DESIGN:

All hysterectomies for benign disease performed at the Kaiser Permanente Fontana Medical Center in Fontana, CA, in 2012 were reviewed for length of surgery, length of stay, complications, and readmissions. A three-tiered category system was developed from four preoperative parameters (body mass index, number of vaginal deliveries, clinical uterine size, and history of major abdominal surgery) to anticipate length and difficulty of surgery.

MAIN OUTCOME MEASURES:

Rates of MIH, complications, and readmissions as well as length of surgery and length of stay for similarly difficult hysterectomies. These outcomes were compared with surgeons' and assistants' experience.

RESULTS:

Of 576 hysterectomies performed for benign disease, 89% were MIH with a 3% complication rate and 4% readmission rate. An increase in the hysterectomy category was statistically significantly associated with longer surgery times and a higher percentage of laparotomy. With the most experienced assistants, the MIH rate was 98%.

CONCLUSIONS:

Using 4 preoperative parameters, the average operating time for hysterectomy for benign disease can be predicted. A higher hysterectomy category predicts a more difficult surgery. Our center has increased its MIH rate to 89% while maintaining safety.

PMID:
26222092
PMCID:
PMC4625993
DOI:
10.7812/TPP/15-023
[Indexed for MEDLINE]
Free PMC Article

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