Guidelines for selecting the route of hysterectomy: Application in a resident clinic population
Drs. S. Robert Kovac,¹ Sheela Barhan¹,  Margit Lister², Lori Tucker², Mardi Bishop², Adrija Das^2
1Emory University School of Medicine
Atlanta, Georgia
²Wright State University School of Medicine
Dayton, Ohio

Objective:   To evaluate the effectiveness of the Society of Pelvic Reconstructive Surgeons guidelines for determining the   route of hysterectomy in a resident clinic population. 

Methods:   A total of 407 consecutive women from the resident clinic population at Wright State University in Dayton, Ohio, between October 1, 1994, and December 31, 1999, were prospectively assigned to abdominal or vaginal hysterectomy groups according to SPRS guidelines.  The women’s age, race, pre- and postoperative uterine weights, lengths of stay, laparoscopic scores, operative time, and complications were compared.

Results:   Vaginal hysterectomy was successfully completed 91.8% of the women.  As expected, vaginal hysterectomy required the shortest operative time and length of stay and was associated with fewer complications than the abdominal approach (P<0.01).  Laparoscopic assistance was necessary in 25.8% of patients to assess extrauterine pathology.

Conclusions:   Resident physicians who followed the practice guidelines reduced the ratio of abdominal to vaginal hysterectomy from 3:1 to 1:11.  Applying practice guidelines for selecting the route of hysterectomy can increase the ratio of vaginal hysterectomies performed in residency programs and help eradicate inconsistencies in health care delivery that currently exist.