Changes in Hysterectomy Trends and Patient Outcomes Following the Implementation of a Clinical Pathway [7]

INTRODUCTION: The goal of this project is to describe the development and implementation of an evidence-based hysterectomy clinical pathway to reduce unnecessary variations in care and to promote improved patient outcomes at a reduced cost. This study characterized the longitudinal impact of hysterectomy pathway implementation on the number of total abdominal hysterectomy (TAH) procedures performed between fiscal years (FY) 2012 to 2014. METHODS: All noncancerous hysterectomy surgeries performed at University of Pittsburgh Medical Center (UPMC) hospitals from FY 2012 to FY 2014 were identified through various systems including Medipac and EpicCare. We analyzed the cases by surgical approach (TAH vs minimally invasive hysterectomy), age, and surgical indication. Changes over time were analyzed using Cochran-Armitage test for linear trends. RESULTS: A total number of 6,544 patients were included in this study (mean age 48.6 years, SD 11.69). The three most common indications for hysterectomy were: leiomyoma, menstruation disorders, and endometriosis. In FY 2012, 28.59% of hysterectomies performed due to noncancerous conditions were TAH, however, this number declined in FY 2013 to 23.35%, and further declined in FY 2014 to 17.86%. Overall, there was a significant reduction in the rate of TAH procedures, from 28.59% in FY 2012 to 17.86% in FY 2014 (P for trend<.001). In addition, there was a trend for reduction in wound infections, hospital readmissions, and complications. CONCLUSION/IMPLICATIONS: Implementation of a hysterectomy pathway has been associated with a decrease in the number of TAH hysterectomy procedures, reduced costs to the healthcare system, and improvements in patient outcomes.