Costs and Charges Associated With Three Alternative Techniques of Hysterectomy

Dorsey, James H.; Holtz, Patrice M.; Griffiths, Robert I.; McGrath, Margaret; Steinberg, E. P.

doi:10.1097/00006254-199704000-00011

Cited by 32 publications

(46 citation statements)

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“…Among these three factors, we found that poor familiarity among patients as well as surgeons was the key factor for the lack of popularity of NDVH. This was also observed by Dorsey et al [16] and Rogo et al [17]. Majority of rural women being illiterate were ignorant about a vaginal surgery but on being counselled; they willingly accepted the procedure with open mind and outcome was better than they expected because pain and disturbance in daily routine was their chief concern.…”

Section: Discussionsupporting

confidence: 55%

Non-decent Vaginal Hysterectomy in Rural Setup of MP: A Poor Acceptance

Jain

Chandrakar

2016

J Obstet Gynecol India

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Objective NDVH is a minimally invasive, safe, effective, and economical surgery. Still AH is preferred for benign gynaecological indications. Our study aims to promote NDVH in all technically possible cases by adequate counselling of the patient. Methods This prospective observational study enrolled 100 women seeking hysterectomy for benign gynaecological conditions (excluding prolapse) in a teaching hospital.Women were counselled on the basis of 'PREPARED' questionnaire to assess their awareness about NDVH and were offered NDVH as the proposed surgery and result is analysed. Results We observed that there was a little awareness about NDVH and its outcome among the subjects. Ten out of 100 patients refused to perform NDVH after counselling and underwent TAH. Rest of the 90 patients opted for NDVH. Forty out of 90 patients were aware about NDVH, but they were sceptical about the outcome, and 50 were totally unaware. After applying 'PREPARED' questionnaire and counselling, we could motivate them to accept NDVH. It was successful in all cases except one where laparotomy was done for ovarian artery retraction. With no significant post-operative complications, early return to routine activity and low cost of surgery, all patients were satisfied with surgical outcome and improved quality of life. 123 the procedure. Most of the abdominal hysterectomy can be converted successfully to NDVH in technically feasible cases by experienced hands so adequate training to gynaecology residents is the need of the time. NDVH is economical to the patient as well as for the healthcare system.

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Section: Discussionsupporting

confidence: 55%

Non-decent Vaginal Hysterectomy in Rural Setup of MP: A Poor Acceptance

Jain

Chandrakar

2016

J Obstet Gynecol India

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“…Conversely, preoperative identification of diploid tumors, along with evaluation of tumor grade and histologic type, would significantly improve the selection of patients with very-low-risk disease, for whom less aggressive treatment may be adequate. In this latter group, a minimally invasive approach, such as a Class I vaginal hysterectomy with bilateral salpingooophorectomy, 52 may reduce surgical risks, complications, hospital stay, and costs, 53,54 while providing the same chance of cure. 55,56 Taken together, these data suggest that preoperative evaluation of tumor ploidy may be very useful in tailoring treatment to the individual patient and should be included in the standard management of endometrial cancer.…”

Section: Discussionmentioning

confidence: 99%

Ten‐year results of a prospective study on the prognostic role of ploidy in endometrial carcinoma

Susini

Amunni

Molino

et al. 2007

Cancer

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BACKGROUND.To improve the outcome of endometrial cancer patients, a more accurate prognostic assessment is mandatory. The aims of the study were to evaluate the role of flow cytometric DNA ploidy as an independent prognostic factor in patients with endometrial cancer and to verify if ploidy was able to distinguish patients with different prognosis into homogeneous subgroups for grade of differentiation and stage.METHODS.In a prospective study, DNA ploidy was evaluated from fresh tumor samples in 174 endometrial cancer patients who underwent surgery as the first treatment. Ploidy, as well as classical parameters, were analyzed in relation to the length of disease‐free survival and disease‐specific survival.RESULTS.DNA aneuploidy was found in 49 patients (28.2%). Patients with DNA‐aneuploid tumors had a significantly reduced disease‐free interval and disease‐specific survival (P < .0001). The 10‐year survival probability was 53.2% for DNA‐aneuploid patients and 91.0% for patients with DNA‐diploid tumors. By multivariate analysis DNA‐aneuploid type was the strongest independent predictor of poor outcome, followed by age and stage. Patients with DNA‐aneuploid tumor had a significantly higher risk ratio for recurrence (5.03) and death due to disease (6.50) than patients with DNA‐diploid tumors. Stratification by DNA‐ploidy within each group by grade of differentiation allowed identification of patients with significantly different outcome. In grade 2 tumors, 10‐year survival was 45.0% in aneuploid cases and 91.9% in diploid cases (P < .0001). Patients with advanced‐stage (>I) diploid tumor did significantly better than patients with stage I aneuploid tumor (P = .04).CONCLUSIONS.The presence of DNA‐aneuploid type in endometrial cancer identifies high‐risk cases among the patients considered ‘low risk’ according to stage and grade of differentiation. Cancer 2007. © 2007 American Cancer Society.

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“…Several publications have compared costs among the various surgical approaches, consistently favoring vaginal surgery (12,28,29). In January 2015, United HealthCare Services, Incorporated, released a network bulletin outlining changes in the company's requirements for preauthorization of hysterectomy procedures (30).…”

Section: Discussionmentioning

confidence: 99%

10: Determining the optimal route of hysterectomy for benign indications: A clinical decision tree algorithm

Schmitt

Carranza

Weaver

et al. 2016

American Journal of Obstetrics and Gynecology

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Objective-To evaluate practice change after initiation of a robotic surgery program using a clinical algorithm to determine the optimal surgical approach to benign hysterectomy.Methods-A retrospective post-robot cohort of benign hysterectomies (2009)(2010)(2011)(2012)(2013) was identified and the expected surgical route was determined from an algorithm using vaginal access and uterine size as decision tree branches. We excluded laparoscopic hysterectomy route. A prerobot cohort (2004)(2005) was used to evaluate a practice change after the addition of robotic technology (2007). Costs were estimated.Results-Cohorts were similar in regard to uterine size, vaginal parity, and prior laparotomy history. In the pre-robot cohort (n=473), 320 hysterectomies (67.7%) were performed vaginally and 153 (32.3%) through laparotomy, with 15.1% (46/305) performed abdominally when the algorithm specified vaginal hysterectomy. In the post-robot cohort (n=1,198), 672 hysterectomies (56.1%) were vaginal; 390 (32.6%), robot-assisted; and 136 (11.4%), abdominal. Of 743 procedures, 38 (5.1%) involved laparotomy and 154 (20.7%) involved robotic technique when vaginal approach was expected. Robotic hysterectomies had longer operations (141 vs 59 minutes, P<.001) and higher rates of surgical site infection (4.7% vs 0.2%, P<.001) and urinary tract infection (8.1% vs 4.1%, P=.05) but no difference in major complications (P=.27) or readmissions (P=.27) compared with vaginal hysterectomy. Algorithm conformance would have saved an estimated $800,000 in hospital costs over 5 years.Conclusion-When a decision tree algorithm indicated vaginal hysterectomy as the route of choice, vaginal hysterectomy was associated with shorter operative times, lower infection rate, and lower cost. Vaginal hysterectomy should be the route of choice when feasible. Financial Disclosure: Dr. Gebhart has served on the advisory board for Astora and received royalties from UpToDate, Inc, and Elsevier BV. The other authors did not report any potential conflicts of interest. Graphical Abstract HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptAn algorithm can be used for decision-making in determining the most appropriate route of hysterectomy to optimize patient outcomes and lower health care delivery costs.

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Costs and Charges Associated With Three Alternative Techniques of Hysterectomy

Cited by 32 publications

References 0 publications

Non-decent Vaginal Hysterectomy in Rural Setup of MP: A Poor Acceptance

Non-decent Vaginal Hysterectomy in Rural Setup of MP: A Poor Acceptance

Ten‐year results of a prospective study on the prognostic role of ploidy in endometrial carcinoma

10: Determining the optimal route of hysterectomy for benign indications: A clinical decision tree algorithm

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