title: Implementation of Hysterectomy Pathway: Impact on Complications.
abstract: Hysterectomy is one of the most common surgical procedures in the United States. For women who need hysterectomy, it is important to ensure that minimally invasive hysterectomy procedures are used appropriately to reduce surgical complications and improve value of care. Although we previously demonstrated a reduction in total abdominal hysterectomy rates after the implementation of hysterectomy pathway treatment algorithm in 2012, this study focuses on exploring the effect of pathways implementation on surgical outcomes.
  
  
  
  All retrospective medical records for hysterectomy surgeries performed for benign indications at University of Pittsburgh Medical Center hospitals between the fiscal years (FY) 2012 and 2014 were identified. We analyzed the health care outcomes by route of surgery and year using Χ2test for categorical data, and non-parametric approaches for non-normal continuous variables.
  
  
  
  A total of 6,569 hysterectomies for benign indications were performed between FY 2012 and 2014. In FY 2012, 1,154 patients (59.15%) had a length of stay of 1 day or less, whereas in FY 2014 this number increased to 1,791 (74.53%; p < .0001). Within 3 years of implementing the pathway, surgical site infections had a reduction of 47%, with a considerable trend toward significance (p = .067).
  
  
  
  Implementation of hysterectomy pathway has been associated with reduction of surgical complications in benign hysterectomy settings. Implementation of clinical pathways offers an opportunity for improving patient outcomes that should be investigated in various health care settings and across procedures.
authors.affiliation: Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Electronic address: Linkfy@mail.magee.edu.
authors.forename: Faina
authors.initials: F
authors.lastname: Linkov
authors.affiliation: Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Amin
authors.initials: A
authors.lastname: Sanei-Moghaddam
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Magee-Womens Hospital, Pittsburgh, Pennsylvania.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Edwards
authors.affiliation: Payer Provider Programs, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Paula J
authors.initials: PJ
authors.lastname: Lounder
authors.affiliation: Payer Provider Programs, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Naveed
authors.initials: N
authors.lastname: Ismail
authors.affiliation: Magee-Womens Research Institute, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Goughnour
authors.affiliation: Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Chaeryon
authors.initials: C
authors.lastname: Kang
authors.affiliation: Divisions of Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Magee-Womens Hospital, Pittsburgh, Pennsylvania.
authors.forename: Suketu M
authors.initials: SM
authors.lastname: Mansuria
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Magee-Womens Hospital, Pittsburgh, Pennsylvania.
authors.forename: John T
authors.initials: JT
authors.lastname: Comerci
mesh_terms: D000328:Adult; D000368:Aged; D019091:Critical Pathways; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods* / Q000639:trends; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010414:Pennsylvania; D011183:Postoperative Complications; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult