Guidelines for the selection of the route of hysterectomy: Application in a resident clinic population

Objective: The purpose of this study was to evaluate the effectiveness of the Society of Pelvic Reconstructive Surgeons guidelines for the determination of the route of hysterectomy in a resident clinic population. Study design: A total of 407 consecutive women from the resident clinic population at Wright State University between October 1, 1994, and December 31, 1999, were assigned prospectively to abdominal or vaginal hysterectomy groups according to Society of Pelvic Reconstructive Surgeons guidelines. The womenʹs age, race, and preoperative and postoperative uterine weights, length of stay, laparoscopic scores, operative time, and complications were compared. Results: Vaginal hysterectomy was completed successfully in 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 < .01). Laparoscopic assistance was necessary in 25.8% of patients to assess extrauterine disease. Conclusion: Resident physicians who followed the practice guidelines reduced the ratio of abdominal-to-vaginal hysterectomy from 3:1 to 1:11. The application of practice guidelines for the selection of the route of hysterectomy can increase the ratio of vaginal hysterectomies that are performed in residency programs and can help eradicate inconsistencies in health care delivery that exist currently. (Am J Obstet Gynecol 2002;187:1521-7.)