Increasing the Technicity Index to 92% in a Community Hospital: A 5-Year Retrospective Review
| Autor: | Justin Mui, Lila Gottenbos, Samar Hejazi, Christine Liu, Fariba Mohtashami |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Vaginal approach medicine.medical_specialty medicine.medical_treatment Patient characteristics Hospitals Community Hysterectomy Young Adult 03 medical and health sciences 0302 clinical medicine Humans Minimally Invasive Surgical Procedures Medicine 030212 general & internal medicine Aged Retrospective Studies Retrospective review 030219 obstetrics & reproductive medicine Surgical approach business.industry Task force General surgery Obstetrics and Gynecology Middle Aged Community hospital Community setting Female business |
| Zdroj: | Journal of Obstetrics and Gynaecology Canada. 41:1709-1716 |
| ISSN: | 1701-2163 |
| DOI: | 10.1016/j.jogc.2019.02.003 |
| Popis: | Objective This study describes the observed trends in hysterectomy routes at Langley Memorial Hospital (LMH) in Langley, British Columbia, over 5 consecutive years. Associations between patient characteristics and surgical approach were explored, and approach-based surgical outcomes were evaluated using the institutional technicity index (TI), defined as the ratio of hysterectomies performed by minimally invasive surgery to all hysterectomies. Methods A retrospective descriptive study involving 706 women who underwent hysterectomy at LMH between January 1, 2012 and December 31, 2016 by six full-time surgeons was performed. From the patient characteristics and surgical outcomes associated with the route of hysterectomy, the annual institutional and overall rates of hysterectomy by type were calculated according to the Canadian Task Force Classification II-2. Results The TI increased from 67% to 92% from 2012 to 2016. Specifically, the proportion of hysterectomies completed by a total laparoscopic approach increased from 37% to 78%, whereas hysterectomies performed by the abdominal or laparoscopic-assisted vaginal approach decreased from 32% to 8% and from 17% to 1%, respectively. Vaginal hysterectomy rates remained constant across the study period. Minimally invasive surgery was associated with significantly reduced surgical blood loss and decreased length of hospital stay, with no difference in surgical time compared with an open approach. Conclusions As far as the study investigators are aware, the TI at LMH is among the highest reported to date in Canada. Potential contributing factors include well-trained and experienced gynaecologic surgeons, readily available peer-to-peer mentorship, certified gynaecologic assistance, dedicated surgical staff, and consistency in the operating room set-up. Hence, achieving a high TI in a community setting is feasible without increasing the risk of surgical complications or length of surgery. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|