Current Clinical Practice Patterns in Total Vaginal Hysterectomy.
Current Clinical Practice Patterns in Total Vaginal Hysterectomy.
- 2023
CONCLUSIONS: This information demonstrates a need for the development of targeted education and interventions to increase the use of evidence-based clinical practice guidelines during TVH for both fellowship-trained and non-fellowship-trained gynecologic surgeons. METHODS: A survey to assess TVH practice patterns was distributed to gynecologic surgical society members for completion. The primary outcome was to compare adherence to practice guidelines between fellowship-trained and non-fellowship-trained gynecologic surgeons. Secondary outcomes included comparing adherence based on age, practice location, and hysterectomy volume. OBJECTIVES: There are no data on current surgical practice patterns for benign total vaginal hysterectomy (TVH) despite recently published guidelines. The objective was to determine gynecologic surgeon practice patterns regarding TVH perioperative interventions and to assess adherence to clinical practice guidelines. RESULTS: Of the 204 respondents, there were 163 (80%) fellowship-trained and 41 (20%) non-fellowship-trained gynecologic surgeons. Fellowship-trained surgeons were more likely than non-fellowship-trained surgeons to use vaginal packing (34% vs 15%, P = 0.028), which is contrary to the recommendations. No cohort followed the guideline recommending a circular cervicovaginal incision. Fellowship-trained surgeons also were more likely than non-fellowship-trained surgeons to use the clamp and suture technique for vessel ligation (88% vs 68%, P = 0.004); otherwise, there were no significant differences between cohorts for adherence to any of the other guidelines. Although fellowship-trained surgeons were adherent to fewer of the guidelines as compared with surgeons without fellowship training, both groups generally adhered to a majority of the clinical practice guidelines for benign TVH.
English
0038-4348
10.14423/SMJ.0000000000001609 [doi] SMJ_230403 [pii]
*Hysterectomy, Vaginal
*Surgeons
Fellowships and Scholarships
Female
Humans
Hysterectomy, Vaginal/mt [Methods]
Hysterectomy/mt [Methods]
Practice Patterns, Physicians'
Surgeons/ed [Education]
Vagina--Automated
MedStar Health Research Institute
MedStar Washington Hospital Center
Female Pelvic Medicine & Reconstructive Surgery Fellowship
Obstetrics and Gynecology
Obstetrics and Gynecology/Female Pelvic Medicine and Reconstructive Surgery
Journal Article
CONCLUSIONS: This information demonstrates a need for the development of targeted education and interventions to increase the use of evidence-based clinical practice guidelines during TVH for both fellowship-trained and non-fellowship-trained gynecologic surgeons. METHODS: A survey to assess TVH practice patterns was distributed to gynecologic surgical society members for completion. The primary outcome was to compare adherence to practice guidelines between fellowship-trained and non-fellowship-trained gynecologic surgeons. Secondary outcomes included comparing adherence based on age, practice location, and hysterectomy volume. OBJECTIVES: There are no data on current surgical practice patterns for benign total vaginal hysterectomy (TVH) despite recently published guidelines. The objective was to determine gynecologic surgeon practice patterns regarding TVH perioperative interventions and to assess adherence to clinical practice guidelines. RESULTS: Of the 204 respondents, there were 163 (80%) fellowship-trained and 41 (20%) non-fellowship-trained gynecologic surgeons. Fellowship-trained surgeons were more likely than non-fellowship-trained surgeons to use vaginal packing (34% vs 15%, P = 0.028), which is contrary to the recommendations. No cohort followed the guideline recommending a circular cervicovaginal incision. Fellowship-trained surgeons also were more likely than non-fellowship-trained surgeons to use the clamp and suture technique for vessel ligation (88% vs 68%, P = 0.004); otherwise, there were no significant differences between cohorts for adherence to any of the other guidelines. Although fellowship-trained surgeons were adherent to fewer of the guidelines as compared with surgeons without fellowship training, both groups generally adhered to a majority of the clinical practice guidelines for benign TVH.
English
0038-4348
10.14423/SMJ.0000000000001609 [doi] SMJ_230403 [pii]
*Hysterectomy, Vaginal
*Surgeons
Fellowships and Scholarships
Female
Humans
Hysterectomy, Vaginal/mt [Methods]
Hysterectomy/mt [Methods]
Practice Patterns, Physicians'
Surgeons/ed [Education]
Vagina--Automated
MedStar Health Research Institute
MedStar Washington Hospital Center
Female Pelvic Medicine & Reconstructive Surgery Fellowship
Obstetrics and Gynecology
Obstetrics and Gynecology/Female Pelvic Medicine and Reconstructive Surgery
Journal Article