Kovac S R
Department of Gynecology and Obstetrics, Emory University School of Medicine, GA, Atlanta 30303, USA.
Int J Gynaecol Obstet. 2000 Nov;71(2):159-69. doi: 10.1016/s0020-7292(00)00316-7.
This study was undertaken to determine if the use of formal guidelines in selecting the route of hysterectomy would improve medical and economic outcomes.
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.
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.
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%.
本研究旨在确定使用正式指南选择子宫切除术途径是否会改善医疗和经济结局。
对在单一中心进行的4595例子宫切除术的数据进行分析，这些手术患者的主要诊断与浸润性癌症或妊娠无关，分析内容包括平均子宫重量、费用、住院时间和并发症。
当使用正式指南确定子宫切除术途径时，90%接受治疗的患者以及100%病理局限于子宫的患者接受了阴道子宫切除术。相比之下，当决策过程未纳入正式指南时，42%接受治疗的患者以及64%病理局限于子宫的患者接受了阴道子宫切除术。
在开展本研究的机构中，每进行1000例子宫切除术，使用这些或类似指南协助临床决策可能节省1184000美元，还可腾出1020个患者床位日，并使并发症减少约20%。
