Vaginal hysterectomies performed in a residency program: can we increase the number?
OBJECTIVE
To evaluate if a concerted effort to increase the number of vaginal hysterectomies performed in a residency program could be accomplished safely when a standard approach vs. a concerted effort was utilized.


METHODS
A retrospective case review was performed for all patients undergoing vaginal hysterectomy at 1 hospital in a residency program. At Denver Health Medical Center, the Gynecology Division made a concerted effort to increase the number of vaginal hysterectomies performed. All hysterectomies from July 1998 to December 2003 were reviewed retrospectively. Abstracted data included age, race, parity, primary diagnosis, past medical history, past surgical history, history of pelvic inflammatory disease/sexually transmitted disease, removal of ovaries, conversion to an abdominal procedure, complications, length of hospital stay, and change in hematocrit.


RESULTS
Over 1,029 hysterectomies were performed during the study period. In the first 3 years, 190 vaginal hysterectomies were performed. During the second 3 years, 320 hysterectomies were performed vaginally; laparoscopic vaginal hysterectomies were excluded. The percentage of vaginal hysterectomies performed increased from 37% to 60%. Age, race, uterine weight, primary diagnosis and past medial history were not significantly different (p>0.05). A significant difference was noted during the second period with regard to parity, previous surgeries, history of sexually transmitted diseases, removal of ovaries, length of hospital stay and complication rate.


CONCLUSIONS
When there is a concerted effort to perform vaginal hysterectomies in lieu of abdominal ones in a residency program, the number can increase without increasing the complication rate.
Department of Obstetrics and Gynecology, University of Colorado Health Science Center and Denver Health Medical Center, Denver 80204, USA. tdunn@dhha.org
Terry S
TS
Dunn
Amy
A
Weaver
Doug
D
Wolf
William
W
Goodard
D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods* / Q000706:statistics & numerical data*; D015907:Hysteroscopy; D015994:Incidence; D007396:Internship and Residency; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014481:United States