title: Guidelines for the selection of the route of hysterectomy: application in a resident clinic population.
abstract: 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.
  
  
  METHODS
  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 women's 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Ga 30303, USA.
authors.forename: S Robert
authors.initials: SR
authors.lastname: Kovac
authors.forename: Sheela
authors.initials: S
authors.lastname: Barhan
authors.forename: Margit
authors.initials: M
authors.lastname: Lister
authors.forename: Lori
authors.initials: L
authors.lastname: Tucker
authors.forename: Mardi
authors.initials: M
authors.lastname: Bishop
authors.forename: Adrija
authors.initials: A
authors.lastname: Das
mesh_terms: D000328:Adult; D019317:Evidence-Based Medicine; D005260:Female; D005831:Genital Diseases, Female / Q000473:pathology / Q000601:surgery; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007045:Hysterectomy, Vaginal / Q000379:methods; D007396:Internship and Residency; D010535:Laparoscopy; D007902:Length of Stay; D011183:Postoperative Complications / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D013997:Time Factors; D014591:Uterine Diseases / Q000473:pathology / Q000601:surgery; D014599:Uterus / Q000473:pathology