Department of Obstetrics and Gynecology, Cooper University Healthcare, Camden, New Jersey; Spectrum Health Medical Group, Urogynecology & Reconstructive Pelvic Surgery, Grand Rapids, Michigan; and Cooper Research Institute, Cooper University Healthcare, and Cooper Medical School of Rowan University, Camden, New Jersey.
Obstet Gynecol. 2021 Apr 1;137(4):641-647. doi: 10.1097/AOG.0000000000004318.
To assess a multiple-tier intervention to increase vaginal hysterectomy rates.
We performed a cohort study assessing hysterectomy performance before and after implementation of a multiple-tier intervention to increase vaginal hysterectomy rates at a single tertiary care medical center. This intervention involved resident and attending education and simulation, professional development, design of a clinical pathway to assist in hysterectomy decision making, and development of a surgical mentorship program.
Data from 698 hysterectomies (253 preintervention and 445 postintervention) were included. The preintervention time period extended from January 1, 2016, to December 31, 2017 (24 months), and the postintervention period from January 1, 2018, to February 28, 2020 (26 months). The intervention was implemented over the month of December 2017 but was not complete until January 1, 2018. The preintervention and postintervention cohorts were similar in most demographic and clinical aspects. Postintervention, the proportion of vaginal hysterectomies was higher (26.5% vs 5.5%, odds ratio 6.2, 95% CI 3.52-11.35), including in those performed for reasons other than prolapse (6.8% vs 0%, P<.001). Logistic regression revealed that prolapse, uterine weight less than 250 g, and surgery during the postintervention cohort were significantly associated with vaginal hysterectomy. Operative complications did not differ significantly by hysterectomy type.
Implementation of a multiple-tier intervention was associated with an increase in vaginal hysterectomies.
评估一项增加经阴道子宫切除术比例的多层干预措施。
我们进行了一项队列研究，评估了在一家三级保健医疗中心实施增加经阴道子宫切除术比例的多层干预措施前后的子宫切除术实施情况。该干预措施包括住院医师和主治医生教育和模拟、专业发展、设计帮助进行子宫切除术决策的临床路径以及建立手术指导计划。
纳入了 698 例子宫切除术（253 例干预前和 445 例干预后）的数据。干预前的时间段为 2016 年 1 月 1 日至 2017 年 12 月 31 日（24 个月），干预后的时间段为 2018 年 1 月 1 日至 2020 年 2 月 28 日（26 个月）。干预措施在 2017 年 12 月实施，但直到 2018 年 1 月 1 日才完全完成。干预前和干预后队列在大多数人口统计学和临床方面相似。干预后，经阴道子宫切除术的比例较高（26.5%比 5.5%，优势比 6.2，95%置信区间 3.52-11.35），包括因脱垂以外的原因进行的手术（6.8%比 0%，P<.001）。逻辑回归显示，脱垂、子宫重量小于 250 g 和干预后队列中的手术与经阴道子宫切除术显著相关。手术并发症与子宫切除术类型无显著差异。
实施多层干预措施与经阴道子宫切除术的增加相关。
