Kelly Erin C, Winick-Ng Jennifer, McClure J Andrew, Peart Teresa, Chou Queena, MacMillan Barry, Leong Yvonne, Vilos Angelos, Vilos George, Welk Blayne, McGee Jacob
Department of Obstetrics and Gynaecology, Western University, London, ON.
Institute for Clinical Evaluative Sciences, London, ON.
J Obstet Gynaecol Can. 2019 Aug;41(8):1168-1176. doi: 10.1016/j.jogc.2018.10.026. Epub 2019 Jan 25.
As quality-based procedures (QBPs) are being established across the province of Ontario, it is important to identify reliable quality indicators (QIs) to ensure that compensation coincides with quality. Hysterectomy is the most commonly performed gynaecologic procedure and as such is a care process for which a QBP is being developed. The aim of this study was to evaluate the technicity index (TI) as a QI for hysterectomy by defining it in the context of specific surgical outcomes and complications.
This population-based, retrospective cohort study included all women who underwent hysterectomy from April 2003 to October 2014 in the province of Ontario. Unadjusted and adjusted generalized linear models were created to assess the effect of a minimally invasive hysterectomy (MIH) approach on the primary outcome measure: all hysterectomy-associated complications (Canadian Task Force Classification II-2).
Of the procedures meeting the study's inclusion criteria, 56.8% were performed using an abdominal hysterectomy approach, whereas 43.2% were performed using an MIH approach. Over the study period, TI improved significantly from 33.23% in 2003 to 58.47% in 2014. During this time span, the overall incidence of all hysterectomy-associated complications was 13.1%.
The composite risk of all hysterectomy-associated complications was reduced by 46% with an MIH approach. The uptake of MIH improved significantly in Ontario from 2003 to 2014 and is adequately assessed by the TI. The TI is an appropriate QI for hysterectomy that can be used to track patients' outcomes and direct hysterectomy funding.
由于安大略省正在全省范围内建立基于质量的程序（QBP），确定可靠的质量指标（QI）以确保补偿与质量相匹配非常重要。子宫切除术是最常见的妇科手术，因此是正在制定QBP的护理过程。本研究的目的是通过在特定手术结果和并发症的背景下定义技术指数（TI），来评估其作为子宫切除术的QI。
这项基于人群的回顾性队列研究纳入了2003年4月至2014年10月在安大略省接受子宫切除术的所有女性。创建未调整和调整后的广义线性模型，以评估微创子宫切除术（MIH）方法对主要结局指标的影响：所有与子宫切除术相关的并发症（加拿大工作组分类II-2）。
在符合研究纳入标准的手术中，56.8%采用经腹子宫切除术，而43.2%采用MIH方法。在研究期间，TI从2003年的33.23%显著提高到2014年的58.47%。在此期间，所有与子宫切除术相关并发症的总体发生率为13.1%。
MIH方法使所有与子宫切除术相关并发症的综合风险降低了46%。2003年至2014年期间，安大略省MIH的采用率显著提高，TI对此进行了充分评估。TI是子宫切除术合适的QI，可用于跟踪患者结局并指导子宫切除术资金分配。
