Validation of hysterectomy indications and the quality assurance process
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This quality assurance process validated 93% of expected pathology indications and 98% of no pathology indications for hysterectomy, simplifying review and leading to the removal of adenomyosis as a reliable indication.
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Abstract
Hysterectomy is one of the most commonly performed major operations in the United States. Despite efforts to explain its high incidence, the perception remains that a significant number of hysterectomies are unjustified. More indications are listed for hysterectomy than for any other major operation. A quality assurance process is presented that requires the surgeon to select preoperatively one designated indication for each hysterectomy performed. The pathology report is expected to verify the surgical indication in 66% of the cases. The other 34% of hysterectomy specimens are not expected to show tissue pathology based on the listed indication. For these cases, predetermined validation criteria must be satisfied in the surgeon's preoperative note. Applying the process in this series of 584 consecutive hysterectomies, 93% (N = 396) of the "pathology expected" indications were verified by the pathology report and 98% (N = 188) of the "no pathology expected" indications were validated by the surgeon's preoperative note. The process of using a single designated indication and reviewing only two documents (the pathology report and the surgeon's preoperative note) has greatly simplified the quality assurance process. This system enables a quality assurance committee to monitor easily the appropriateness of hysterectomy indications for their institution. Information obtained from this process can influence changes regarding the acceptability of certain indications. As a result of this study, adenomyosis, because of its low (38%) verification rate, is no longer considered a reliable preoperative indication for hysterectomy at San Diego Naval Hospital.
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Cited by (12)
- Embolisation des artères utérines dans le traitement de l’adénomyose en Côte d’Ivoire 2025
- Clinico-histopathological correlation of abdominal hysterectomy 2022
- Actual considerations concerning the contribution of histeroscopy to diagnosis and treatment of adenomyosis in infertile patients 2019
- Clinico-Pathological Study of Abdominal Hysterectomies 2018
- Adenomyose utérine, étude clinique et thérapeutique: à propos de 87 cas 2015
- CLINICO-PATHOLOGICAL STUDY OF ABDOMINAL HYSTERECTOMIES 2009
- Transvaginal ultrasound for diagnosis of adenomyosis: a review 2006
- Consensus statement for the management of chronic pelvic pain and endometriosis: proceedings of an expert-panel consensus process 2002
- A case notes analysis of hysterectomy performed for non-neoplastic indications at Liaquat National Hospital, Karachi. 2001
- Abdominal hysterectomy: indications and complications. 1993
- Was That Hysterectomy Really Necessary? Audit of Operative Justification at the Aga Khan University Medical Centre, Karachi 1991
- The impact of a quality assurance process on the frequency and confirmation rate of hysterectomy 1990
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- europepmc
- last seen: 2026-06-11T06:19:48.454388+00:00
- openalex
- last seen: 2026-06-04T00:00:01.174412+00:00
- pubmed
- last seen: 2026-05-13T22:09:10.744835+00:00
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