Outpatient abdominal hysterectomy

A functional clinical pathway

Marvin E. Eastlund, Robert M. Saywell, Terrell W. Zollinger, Kathryn B. Carboneau, Robyn Strubing, Christopher P. Smith

    Research output: Contribution to journalArticle

    Abstract

    Objective The physical, service, and financial outcomes of noncomplex abdominal hysterectomy patients following a 23-hour pathway were compared with outcomes in similar patients who followed a 48-hour pathway and in those who underwent laparoscopically assisted vaginal hysterectomy in a series of 200 patients treated between February 1, 1997 and January 31, 1999. Methods Working from an already established 48-hour clinical pathway for abdominal and vaginal hysterectomy, a new 23-hour pathway was developed to allow selected patients to be treated as outpatients. The 23-hour pathway involved case management, home health care if needed, active pain management, and in most cases, spinal anesthesia. These patients underwent surgery and postoperative care in the hospital or in an ambulatory surgical center. Use of pain and nausea medicine, patient costs, and return-to-work time were measured. The outcomes of the noncomplex abdominal hysterectomy patients following the 23-hour pathway were compared with outcomes in similar patients who followed the 48-hour pathway and in those who underwent laparoscopically assisted vaginal hysterectomy. Results The 23-hour-pathway patients experienced significantly lower hospital costs compared with the 48-hour-pathway patients and the laparoscopically assisted vaginal hysterectomy patients. Pain and nausea control medications were also used less in the 23-hour patients. Recovery times for the 23-hour and laparoscopy patients were similar. Conclusion Clinical pathways have demonstrated the ability to efficiently render quality care and improve outcomes while producing cost savings. The 23-hour pathway for abdominal hysterectomy allows these goals to be achieved.

    Original languageEnglish (US)
    Pages (from-to)63-71
    Number of pages9
    JournalJournal of Pelvic Surgery
    Volume7
    Issue number2
    StatePublished - 2001

    Fingerprint

    Critical Pathways
    Hysterectomy
    Outpatients
    Vaginal Hysterectomy
    Nausea
    Pain
    Aptitude
    Return to Work
    Postoperative Care
    Cost Savings
    Hospital Costs
    Quality of Health Care
    Spinal Anesthesia
    Case Management
    Pain Management
    Home Care Services
    Laparoscopy

    ASJC Scopus subject areas

    • Surgery
    • Obstetrics and Gynecology
    • Urology

    Cite this

    Eastlund, M. E., Saywell, R. M., Zollinger, T. W., Carboneau, K. B., Strubing, R., & Smith, C. P. (2001). Outpatient abdominal hysterectomy: A functional clinical pathway. Journal of Pelvic Surgery, 7(2), 63-71.

    Outpatient abdominal hysterectomy : A functional clinical pathway. / Eastlund, Marvin E.; Saywell, Robert M.; Zollinger, Terrell W.; Carboneau, Kathryn B.; Strubing, Robyn; Smith, Christopher P.

    In: Journal of Pelvic Surgery, Vol. 7, No. 2, 2001, p. 63-71.

    Research output: Contribution to journalArticle

    Eastlund, ME, Saywell, RM, Zollinger, TW, Carboneau, KB, Strubing, R & Smith, CP 2001, 'Outpatient abdominal hysterectomy: A functional clinical pathway', Journal of Pelvic Surgery, vol. 7, no. 2, pp. 63-71.
    Eastlund ME, Saywell RM, Zollinger TW, Carboneau KB, Strubing R, Smith CP. Outpatient abdominal hysterectomy: A functional clinical pathway. Journal of Pelvic Surgery. 2001;7(2):63-71.
    Eastlund, Marvin E. ; Saywell, Robert M. ; Zollinger, Terrell W. ; Carboneau, Kathryn B. ; Strubing, Robyn ; Smith, Christopher P. / Outpatient abdominal hysterectomy : A functional clinical pathway. In: Journal of Pelvic Surgery. 2001 ; Vol. 7, No. 2. pp. 63-71.
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    N2 - Objective The physical, service, and financial outcomes of noncomplex abdominal hysterectomy patients following a 23-hour pathway were compared with outcomes in similar patients who followed a 48-hour pathway and in those who underwent laparoscopically assisted vaginal hysterectomy in a series of 200 patients treated between February 1, 1997 and January 31, 1999. Methods Working from an already established 48-hour clinical pathway for abdominal and vaginal hysterectomy, a new 23-hour pathway was developed to allow selected patients to be treated as outpatients. The 23-hour pathway involved case management, home health care if needed, active pain management, and in most cases, spinal anesthesia. These patients underwent surgery and postoperative care in the hospital or in an ambulatory surgical center. Use of pain and nausea medicine, patient costs, and return-to-work time were measured. The outcomes of the noncomplex abdominal hysterectomy patients following the 23-hour pathway were compared with outcomes in similar patients who followed the 48-hour pathway and in those who underwent laparoscopically assisted vaginal hysterectomy. Results The 23-hour-pathway patients experienced significantly lower hospital costs compared with the 48-hour-pathway patients and the laparoscopically assisted vaginal hysterectomy patients. Pain and nausea control medications were also used less in the 23-hour patients. Recovery times for the 23-hour and laparoscopy patients were similar. Conclusion Clinical pathways have demonstrated the ability to efficiently render quality care and improve outcomes while producing cost savings. The 23-hour pathway for abdominal hysterectomy allows these goals to be achieved.

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