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

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$1184000 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%.