title: Increasing Minimally Invasive Hysterectomy: A Canadian Academic Health Centre Experience.
abstract: OBJECTIVE
  An institution wide strategic plan was established to improve minimally invasive surgery (MIS) across all surgical divisions at The Ottawa Hospital (TOH). The primary objective of this study is to determine the change in MIS hysterectomy rate between 2005 and 2012 at this centre. Secondary objectives include determining the impact on overall length of stay (LOS) in hospital, complications, return to hospital, operating room time, and cost.
  
  
  METHODS
  We performed a retrospective analysis of all hysterectomies for benign disease performed at TOH between 2005 and 2012. Cases were excluded if they were related to pregnancy or classified as "partial hysterectomy." The outcomes and cost of the approaches were compared.
  
  
  RESULTS
  A total of 4337 hysterectomy cases were reviewed. The MIS hysterectomy rate increased from 40.1% in 2005 to 74.2% in 2012. There was a decrease in mean LOS from 2.5 to 1.6 days. This translated to a saving of 1898 inpatient bed days. Compared with laparotomy, laparoscopic hysterectomy was associated with a reduced risk of transfusion and a reduced risk of ileus, and vaginal hysterectomy was associated with an increased risk of postoperative abscess. There was no difference in rates of returning to hospital or other complications between women undergoing abdominal hysterectomy and women undergoing MIS hysterectomy (which included both laparoscopic and vaginal approaches). The mean (SD) cost per approach was $7241 ($1985), $4532 ($1718), and $5637 ($1579) for abdominal hysterectomy, vaginal hysterectomy, and laparoscopic hysterectomy, respectively.
  
  
  CONCLUSIONS
  The initiatives implemented at TOH in 2007 resulted in a significant increase in the MIS hysterectomy rate, a decrease in mean LOS, and substantial theoretical cost savings for the hospital.
authors.affiliation: Department of Obstetrics and Gynecology, University of Ottawa, Ottawa ON; Department of Obstetrics and Gynaecology, Ottawa Hospital Research Institute, Ottawa ON.
authors.forename: Jenna
authors.initials: J
authors.lastname: Gale
authors.affiliation: Department of Obstetrics and Gynaecology, Ottawa Hospital Research Institute, Ottawa ON.
authors.forename: Chris
authors.initials: C
authors.lastname: Cameron
authors.affiliation: Department of Obstetrics and Gynecology, University of Ottawa, Ottawa ON; Department of Obstetrics and Gynaecology, Ottawa Hospital Research Institute, Ottawa ON.
authors.forename: Innie
authors.initials: I
authors.lastname: Chen
authors.affiliation: Department of Obstetrics and Gynaecology, Ottawa Hospital Research Institute, Ottawa ON.
authors.forename: Yanfang
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Department of Obstetrics and Gynecology, University of Ottawa, Ottawa ON; Department of Obstetrics and Gynaecology, Ottawa Hospital Research Institute, Ottawa ON.
authors.forename: Sukhbir S
authors.initials: SS
authors.lastname: Singh
mesh_terms: D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000191:economics / Q000706:statistics & numerical data*; D007813:Laparotomy / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data*; D019060:Minimally Invasive Surgical Procedures / Q000191:economics / Q000706:statistics & numerical data*; D009864:Ontario / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies
keywords: Cost analysis; hysterectomy; laparoscopy; length of stay; minimally invasive surgery