Achieving high value in the surgical approach to hysterectomy

Whiteside, James L.; Kaeser, C.T.; Ridgeway, Beri

doi:10.1016/j.ajog.2018.11.124

Cited by 17 publications

(11 citation statements)

References 30 publications

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“…However, these variables may be valued differently by the patient, health care provider performing the procedure, and healthcare systems. For example, the latter may consider procedure cost, technique availability at a locoregional level, faster recovery time, or difficulty of surgical training for adequate technique performance as most important variables (24). On the other hand, physicians may consider more important variables such as required operative time, received professional fees for performing a given technique, as well as their own personal training among others.…”

Section: Discussionmentioning

confidence: 99%

What Matters Most To Women Undergoing Hysterectomy?

Ríos

López

Cifuentes

et al. 2021

Preprint

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Study objective: to gain an understanding of patient preferences regarding choice of surgical approach to hysterectomy. Design: Cross-sectional, analytical study. Setting: Tertiary hospital, referral center for gynecologic surgery in Medellin, Colombia Patients: A total of 300 women, 150 who were scheduled for hysterectomy and 150 women who were not undergoing any surgical procedure. Interventions: A questionnaire listing advantages of laparoscopic, vaginal, and abdominal hysterectomy was designed and applied to all participating women, who were then asked to rank in order of relevance the surveyed items. Answers and demographic variables were collected. Measurements and Main results: Average scores were calculated for each of the listed variables, and the difference of medians between groups (women scheduled to undergo hysterectomy and women who were not undergoing surgery) was analyzed. Difference of medians was also analyzed by grouping participants based on educational level. Participating women ranked as most important: safety, pain, duration of sick leave, scars, operative time, duration of surgical training, and cost. Altogether, women preferred advantages offered by laparoscopic hysterectomy over those provided by vaginal or abdominal approaches. Conclusion: Patient preferences should be taken into account upon deciding the surgical approach to hysterectomy, as they may differ from those of the physician. Key Words: Hysterectomy, preferences, approach

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Section: Discussionmentioning

confidence: 99%

What Matters Most To Women Undergoing Hysterectomy?

Ríos

López

Cifuentes

et al. 2021

Preprint

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“…Currently in gynecological surgery, it is recommended to use vaginal hysterectomy when feasible, for benign pathology. [1][2][3][4][5][6][7][8][9] Total laparoscopic hysterectomy (LH) is a technique with a longer learning curve but with minimally invasive surgery advantages including reduced invasiveness, shorter hospital stay, faster postoperative recovery, greater precision of surgical maneuvers, and less blood loss. 10 It also provides a better vision of anatomical spaces, permits the surgeon to perform simultaneous pelvic and abdominal surgeries, and allows the surgeon to operate large and nonprolapsed uteri.…”

Section: Introductionmentioning

confidence: 99%

Healthcare and Indirect Cost of the Laparoscopic vs. Vaginal Approach in Benign Hysterectomy

Martínez-Maestre

Jódar-Sánchez

Calderón-Cabrera

et al. 2022

JSLS

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Background and Objectives: The aim of this study was to analyze indirect costs of vaginal and laparoscopic routes for hysterectomy to determine whether this makes a difference in total costs when considering route for surgery.Methods: A five-year observational retrospective cohort study was conducted in an academic tertiary care center. A total of 517 patients scheduled for total laparoscopic hysterectomy (n = 137) and vaginal hysterectomy (n = 380) for benign conditions between January 1, 2008 and December 31, 2012 meeting inclusion criteria were reviewed.Results: Indirect costs were higher in the vaginal hysterectomy group compared to the laparoscopic hysterectomy group (mean cost e3,239.86 vs. e1,371.58; cost increase of e1,868.28; p < .001). Indirect costs due to lostwork-productivity were the most important, represented by 97.7% in the vaginal group and 93.6% in the laparoscopic group.Conclusion: Among women undergoing hysterectomy for benign disease, laparoscopic hysterectomy appears to be superior to vaginal hysterectomy when indirect costs are analyzed in a five-year temporal horizon. Laparoscopic hysterectomy is a good alternative to vaginal hysterectomy when technically feasible as both present comparable advantages. The surgical approach to hysterectomy should be decided in light of the relative benefits and hazards, which will depend on clinical circumstances and surgical expertise.

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“…One barrier is preconceived physician beliefs, as previously discussed, about contraindications to minimally invasive surgery-for example, patient weight or uterine size. Standardized surgical decision tools applying evidence-based protocols can increase the use of vaginal surgery [42]. Mandatory surgeon training on minimally invasive surgery techniques can also reduce rates of abdominal hysterectomy [42].…”

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confidence: 99%

“…Standardized surgical decision tools applying evidence-based protocols can increase the use of vaginal surgery [42]. Mandatory surgeon training on minimally invasive surgery techniques can also reduce rates of abdominal hysterectomy [42]. However, such training and mentorship may not be available to all gynecologists who desire it [43].…”

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confidence: 99%