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Routine intravenous pyelograms before hysterectomy in cases of benign disease: possibly effective, definitely expensive.

Publication ,  Journal Article
Simel, DL; Matchar, DB; Piscitelli, JT
Published in: Am J Obstet Gynecol
November 1988

Intraoperative ureteral injuries are potentially serious iatrogenic complications. Routine preoperative intravenous pyelograms might decrease the risk of such injuries during hysterectomy in cases of nonmalignant disease, but no prospective studies have been conducted to determine their effectiveness. Since gynecologists must frequently decide whether to obtain pyelograms, we used decision analysis to determine how costly routine pyelograms would be and under what circumstance pyelograms might be especially justifiable. Our cost-effectiveness study was based on decision analysis techniques, with the best available estimates from the literature, and on expert opinion. These estimates were varied over a broad range during a sensitivity analysis so as not to bias the results. At a baseline ureteral incidence injury rate of 0.5%, the marginal cost-effectiveness ratio indicates 833 pyelograms would be obtained to prevent a single injury and approximately $3.33 million would be spent to prevent a single death. As the probability of an injury increases, the marginal cost-effectiveness ratio is less dependent on the test efficacy and is more modest. Since abnormal ureteral anatomy probably predicts ureteral injury, we suggest selectively obtaining preoperative pyelograms only when the probability of an abnormality is high.

Duke Scholars

Published In

Am J Obstet Gynecol

DOI

ISSN

0002-9378

Publication Date

November 1988

Volume

159

Issue

5

Start / End Page

1049 / 1053

Location

United States

Related Subject Headings

  • Uterine Diseases
  • Urography
  • Sensitivity and Specificity
  • Preoperative Care
  • Obstetrics & Reproductive Medicine
  • Models, Theoretical
  • Injections, Intravenous
  • Hysterectomy
  • Humans
  • Female
 

Citation

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ICMJE
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Simel, D. L., Matchar, D. B., & Piscitelli, J. T. (1988). Routine intravenous pyelograms before hysterectomy in cases of benign disease: possibly effective, definitely expensive. Am J Obstet Gynecol, 159(5), 1049–1053. https://doi.org/10.1016/0002-9378(88)90409-7
Simel, D. L., D. B. Matchar, and J. T. Piscitelli. “Routine intravenous pyelograms before hysterectomy in cases of benign disease: possibly effective, definitely expensive.Am J Obstet Gynecol 159, no. 5 (November 1988): 1049–53. https://doi.org/10.1016/0002-9378(88)90409-7.
Simel DL, Matchar DB, Piscitelli JT. Routine intravenous pyelograms before hysterectomy in cases of benign disease: possibly effective, definitely expensive. Am J Obstet Gynecol. 1988 Nov;159(5):1049–53.
Simel, D. L., et al. “Routine intravenous pyelograms before hysterectomy in cases of benign disease: possibly effective, definitely expensive.Am J Obstet Gynecol, vol. 159, no. 5, Nov. 1988, pp. 1049–53. Pubmed, doi:10.1016/0002-9378(88)90409-7.
Simel DL, Matchar DB, Piscitelli JT. Routine intravenous pyelograms before hysterectomy in cases of benign disease: possibly effective, definitely expensive. Am J Obstet Gynecol. 1988 Nov;159(5):1049–1053.
Journal cover image

Published In

Am J Obstet Gynecol

DOI

ISSN

0002-9378

Publication Date

November 1988

Volume

159

Issue

5

Start / End Page

1049 / 1053

Location

United States

Related Subject Headings

  • Uterine Diseases
  • Urography
  • Sensitivity and Specificity
  • Preoperative Care
  • Obstetrics & Reproductive Medicine
  • Models, Theoretical
  • Injections, Intravenous
  • Hysterectomy
  • Humans
  • Female