title: Changes in Hysterectomy Trends After the Implementation of a Clinical Pathway.
abstract: OBJECTIVE
  To investigate the effect of hysterectomy pathway implementation on the proportion of total abdominal hysterectomy (TAH) procedures performed between fiscal years 2012 and 2014.
  
  
  METHODS
  We conducted a retrospective medical record review. All hysterectomy surgeries performed for benign indications at University of Pittsburgh Medical Center hospitals from fiscal year 2012 to fiscal year 2014 were identified through various systems including Medipac and EpicCare. We analyzed the cases by surgical approach (TAH compared with minimally invasive hysterectomy), age, and indication of surgery. 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. The mean age of the participants was 48.6 years (standard deviation 11.69). In fiscal year 2012, of 1,934 hysterectomies performed as a result of noncancerous conditions, 538 were TAH procedures (27.8%). However, this number declined in fiscal year 2013 to 22% (485 TAH procedures of 2,186 hysterectomies) and further declined in fiscal year 2014 to 17% (413 TAH surgeries of 2,424 hysterectomies). Overall, there was a significant reduction in the proportion of TAH procedures, from 27.8% in fiscal year 2012 to 17% in fiscal year 2014 (P for trend <.001). After adjusting for surgery indication, the decreasing trend of TAH procedures still persisted (P for trend <.001).
  
  
  CONCLUSIONS
  Implementation of a hysterectomy pathway has been associated with a decrease in the proportion of TAH hysterectomy procedures.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Women's Research Institute, University of Pittsburgh School of Medicine, the Departments of Biostatistics and Epidemiology, University of Pittsburgh Graduate School of Public Health, and the Payer Provider Programs and the Divisions of Gynecologic Oncology and Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology, and Reproductive Services, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Amin
authors.initials: A
authors.lastname: Sanei-Moghaddam
authors.forename: Tianzhou
authors.initials: T
authors.lastname: Ma
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Goughnour
authors.forename: Robert P
authors.initials: RP
authors.lastname: Edwards
authors.forename: Paula J
authors.initials: PJ
authors.lastname: Lounder
authors.forename: Naveed
authors.initials: N
authors.lastname: Ismail
authors.forename: John T
authors.initials: JT
authors.lastname: Comerci
authors.forename: Suketu M
authors.initials: SM
authors.lastname: Mansuria
authors.forename: Faina
authors.initials: F
authors.lastname: Linkov
mesh_terms: D000291:Adnexal Diseases / Q000601:surgery*; D000328:Adult; D019091:Critical Pathways; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods / Q000639:trends*; D008599:Menstruation Disturbances / Q000601:surgery; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery; D017699:Pelvic Pain / Q000601:surgery; D012189:Retrospective Studies; D014591:Uterine Diseases / Q000601:surgery*