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The appropriateness of recommendations for hysterectomy

OBSTETRICS AND GYNECOLOGY 2000年第2期95卷 199-205页

作者： Broder, MS Kanouse, DE Mittman, BS Bernstein, SJ Univ Calif Los Angeles Sch Med Dept Obstet & Gynecol Los Angeles CA 90095 USA RAND Corp Santa Monica CA USA Vet Adm Med Affairs Sepulveda CA USA Univ Michigan Vet Affairs Med Ctr Ann Arbor MI 48109 USA Univ Michigan Dept Med Ann Arbor MI 48109 USA Univ Michigan Dept Hlth Management & Policy Ann Arbor MI 48109 USA

Objective: To evaluate the appropriateness of recommendations for hysterectomies done for nonemergency and nononcologic indications. Methods: We assessed the appropriateness of recommendations for hysterectomy for 497 women who had the operation between August 1993 and July 1995 in one of nine capitated medical groups in Southern California. Appropriateness was assessed using two sets of criteria, the first developed by a multispecialty expert physician panel using the RAND/University of California-Los Angeles appropriateness method, and the second consisting of the ACOG criteria sets for hysterectomies. The main outcome measure was the appropriateness of recommendation for hysterectomy, based on expert panel ratings and ACOG criteria sets. Results: The most common indications for hysterectomy were leiomyomata (60% of hysterectomies), pelvic relaxation (11%), pain (9%), and bleeding (8%). Three hundred sixty-seven (70%) of the hysterectomies did not meet the level of care recommended by the expert panel and were judged to be recommended inappropriately. ACOG criteria sets were applicable to 71 women, and 54 (76%) did not meet ACOG criteria for hysterectomy. The most common reasons recommendations for hysterectomies considered inappropriate were lack of adequate diagnostic evaluation and failure to try alternative treatments before hysterectomy. Conclusion: Hysterectomy is often recommended for indications judged inappropriate. Patients and physicians should work together to ensure that proper diagnostic evaluation has been done and appropriate treatments considered before hysterectomy is recommended. (C) 2000 by The American College of Obstetricians and Gynecologists.

关键词：规范/统计学和数值数据加利福尼亚妇科学/标准子宫切除术/标准子宫切除术/统计学和数值数据洛杉矶非必要的操作/统计学和数值数据子宫疾病/诊断子宫疾病/外科学妇女卫生成年人女(雌)性人类中年人

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Hysterectomy or an alternative?

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HOSPITAL PRACTICE 2000年第9期35卷 55-62页

作者： Shoupe, D Univ So Calif Sch Med Los Angeles CA 90089 USA

Even though hysterectomy remains an appealing solution for a number of nonmalignant gynecologic conditions, patients are often scheduled for surgery without proper evaluation or consideration of an alternative. For symptoms associated with uterine fibroids or endometriosis, there are alternative treatments that cause less morbidity, are less costly, and often are equally effective. Conservative management may also be appropriate for selected patients with early gynecologic cancer.

关键词：子宫内膜异位症/治疗卫生服务滥用/统计学和数值数据子宫切除术/经济学子宫切除术/统计学和数值数据子宫切除术/利用知情同意平滑肌瘤/治疗年患病率病人遴选骨盆痛/治疗卫生保健质量危险因素美国子宫肿瘤/治疗子宫脱垂/治疗女(雌)性人类

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Autologous blood transfusion does not reduce postoperative infection rates in elective surgery

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AMERICAN JOURNAL OF SURGERY 1999年第6期178卷 549-554页

作者： Sauaia, A Alexander, W Moore, EE Stevens, BR Rosen, H Dunn, TR Colorado Fdn Med Care Aurora CO 80014 USA Denver Hlth Med Ctr EEM Aurora CO USA

BACKGROUND: The influence of blood transfusions in the risk of postoperative infection remains controversial. We examined the association between autologous (AB) and homologous (HB) blood transfusions with postoperative infection in elective surgery. METHODS: The medical records of 991 Medicare patients aged greater than or equal to 65 years submitted to hysterectomy and hip and knee replacement were reviewed. Logistic regression analysis was used to control for age, comorbidity, year, and type of procedure, RESULTS: Overall, 451 (46%) patients required transfusions. AB was given to 324 (72%), HB to 94 (21%);33 (7%) patients received both, Forty-two patients (4%) developed postoperative infections. The infection rate was not different among patients receiving HE (7%), AB (5%), AB+HB (0), and nontransfused patients (4%);P = 0.18). After adjustment for confounders, HB and AB remained not associated with infections. CONCLUSION: In elective surgery with small volume transfusion, neither AB nor HE transfusions were associated with an increased risk of postoperative infections. Am J Surg. 1999;178:549-555, (C) 1999 by Excerpta Medica, Inc.

关键词：关节成形术置换髋/统计学和数值数据关节成形术置换膝/统计学和数值数据输血自体/统计学和数值数据科罗拉多/流行病学子宫切除术/统计学和数值数据感染/流行病学 Logistic模型 Medicare/统计学和数值数据手术后并发症/流行病学手术后并发症/预防和控制危险因素外科手术选择性/统计学和数值数据美国老年人女(雌)性人类男(雄)性

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Endometrial ablation as an alternative to hysterectomy.

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AORN journal 2003年第2期77卷 322-324,327页

作者： League, Diane D Mt. Carmel St. Ann's Hospital Westerville Ohio USA.

In the United States, as many as two million women (ie, 22%) each year will consult a physician about menorrhagia (ie, excessive menstrual bleeding). Seven hundred thousand hysterectomies are performed in the United States each year for symptomatic menorrhagia. The procedure cost, risk, and complications, combined with the fact that a large number of posthysterectomy specimens show no abnormality, suggest that the majority of hysterectomies performed for menorrhagia are unnecessary. These data suggest that a less invasive procedure that destroys the endometrial lining but preserves the uterus would be a beneficial procedure for patients with excessive uterine bleeding. Treatment for menorrhagia may include hormone therapy, endometrial curettage, endometrial ablation, and hysterectomy. Women who are opposed to hysterectomy and those for whom other treatment options were unsuccessful can consider ablation rather than hysterectomy.

关键词：导管消融术/副作用导管消融术/方法导管消融术/护理导管插入术/方法电外科手术/副作用电外科手术/方法电外科手术/护理子宫内膜/外科学热温度/治疗应用子宫切除术/统计学和数值数据月经过多/护理月经过多/外科学月经过多/治疗围手术期护理/方法非必要的操作女(雌)性人类

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Cervical screening programme, England: 1997-98

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JOURNAL OF MEDICAL SCREENING 1999年第2期6卷 57-57页

作者： Patnick, J Lancucki, L NHS Cervical Screening Programme Sheffield S11 9PS S Yorkshire England SD2B Dept Hlth London SE1 6LH England

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100 total laparoscopic hysterectomies in private practice in Brazil

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JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 1999年第2期6卷 169-171页

作者： Jaenisch, JB Junior, WA Mae de Deus Hosp Porto Alegre RS Brazil

Study Objective. To evaluate of 100 total laparoscopic hysterectomies performed in a private practice. Design. Prospective observational study (Canadian Task Force classification II-2). Setting. Private hospital. Patients. One hundred women. Interventions. Total laparoscopic hysterectomy (TLH). Measurements and Main Results. The most common indications for TLH were chronic menorrhagia (uterine myomas), pelvic pain (severe endometriosis), and uterine enlargement. Four of our first 20 procedures were converted to laparotomy in which bipolar was used exclusively. In the others cases the Endo cia stapler was used in the first step of the procedure (section of broad ligaments) in combination with bipolar coagulation. Mean operating time was 90 minutes (range 45-150 min) and hospital stay was 36 hours (range 18 hrs-2 days). The two intraoperative complications were hemorrhage requiring blood transfusion and a rectal injury;the lour postoperative complications were two cases of vesicovaginal fistula, and one each of colonic vaginal fistula and vaginal cuff infection (total complication rate 5%). Ninety-six women returned to work in 2 weeks. Conclusion. Total laparoscopic hysterectomy can be performed safely and effectively when the surgical team is sufficiently trained and experienced in managing complications. We believe that it will become standard treatment for benign uterine disease.

关键词：巴西评价研究随访研究子宫切除术/方法子宫切除术/统计学和数值数据腹腔镜检查/方法腹腔镜检查/统计学和数值数据住院时间私人开业/统计学和数值数据前瞻性研究治疗结果子宫疾病/诊断子宫疾病/外科学成年人老年人女(雌)性人类中年人

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Decrease in the number of abdominal hysterectomies after introduction of laparoscopic hysterectomy

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JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2000年第4期7卷 523-525页

作者： Robertson, EA de Blok, S Onze Lieve Vrouwe Gasthuis Dept Obstet & Gynecol NL-1090 HM Amsterdam Netherlands

Study Objective. To compare two 3-year periods before and after laparoscopic hysterectomy was introduced into our resident training program. Design. Retrospective analysis (Canadian Task Force classification 11-2). Setting. Teaching hospital in the Netherlands. Patients. Women undergoing hysterectomy from 1992 to 1994 and 1995 to 1997. Intervention. Abdominal, vaginal, and laparoscopic hysterectomies. Measurements and Main Results. Laparoscopic hysterectomy significantly (p<0.002) reduced the number of abdominal hysterectomies. Conclusion. To reduce the number of abdominal hysterectomies, it is essential that the laparoscopic procedure be taught to residents.

关键词：子宫切除术/方法子宫切除术/统计学和数值数据宫腔镜检查/方法宫腔镜检查/统计学和数值数据发病率腹腔镜检查/方法荷兰回顾性研究敏感性与特异性成年人女(雌)性人类中年人

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Pelvic abscess in women in the tropics: a 10-year review in Enugu, Nigeria

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TROPICAL DOCTOR 2000年第1期30卷 52-52页

作者： Aniebue, UU Anya, SE Aniebue, PN Ikeme, AC Univ Nigeria Teaching Hosp Dept Obstet & Gynaecol Enugu Nigeria

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