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The Effect of Preoperative Checklists on Final Histology and Rates of Hysterectomy for Benign Conditions

Hullfish, Kathie L. MD*†; Henry, Erick MPH; Ferguson, James E. II MD, MBA*

Female Pelvic Medicine & Reconstructive Surgery: May/June 2012 - Volume 18 - Issue 3 - p 143–147
doi: 10.1097/SPV.0b013e3182523a03
Original Articles
Journal Club

Objectives: Our null hypothesis was that the introduction of preoperative hysterectomy checklists for fibroids, dysfunctional uterine bleeding (DUB), and chronic pelvic pain (CPP) would not affect the rate of hysterectomy or the proportion of cases with nonconfirmable final pathology.

Study Design: Using a prospective 6-month cohort, we compared the rate of hysterectomy (using ambulatory current procedural terminology codes for all eligible patients) and the preoperative diagnoses to final histologic diagnoses, to a baseline 6-month retrospective cohort. We also sought to determine the proportion of completed preoperative checklists among eligible cases.

Results: Checklist implementation was associated with a significant decrease in the hysterectomy rate for DUB: 25 (15.2%) of 165 fell to 12 (6.5%) of 185 (P = 0.014): for CPP: 11 (10.9%) of 101 to 3 (2.9%) of 105 (P = 0.044), as well as for the combined total rate: 86 (25.2%) of 341 to 52 (15.2%) of 342 (P = 0.002). There was a 50% decrease in nonconfirmable pathology for all cases: 21 of 86 at baseline compared to 6 of 52 after intervention (P = 0.049).

Conclusion: In this 6-month pilot analysis, the use of preoperative hysterectomy checklists for 3 common nonmalignant conditions (fibroids, DUB, and CPP) was associated with a statistically significant decrease in hysterectomy rates and overall nonconfirmable pathology.

The use of standardized preoperative checklists was associated with a decrease in the rate of hysterectomy for benign conditions and a decrease in the number of cases with nonconfirmable pathology for dysfunctional uterine bleeding and chronic pelvic pain.

From the Departments of *Obstetrics and Gynecology and †Urology, University of Virginia Health System, Charlottesville, VA; and ‡Institute for Health Care Delivery Research, Intermountain Healthcare, Salt Lake City, UT.

Reprints: Kathie L. Hullfish, MD, Departments of Obstetrics and Gynecology and Urology, PO Box 801305, University of Virginia Health Systems, Charlottesville, VA 22908. E-mail: khullfish@virginia.edu.

The authors declare that they have nothing to disclose.

© 2012 by Wolters Kluwer Health | Lippincott Williams & Wilkins