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Appropriateness of Hysterectomy as Treatment for Benign Gynecological Conditions.

Publication ,  Journal Article
Wright, MA; Kinlaw, AC; McClurg, AB; Carey, E; Doll, KM; Vines, AI; Olshan, AF; Robinson, WR
Published in: J Womens Health (Larchmt)
October 2024

Objective: To assess the appropriateness of hysterectomies performed at a large tertiary health system using the 1997 RAND appropriateness classification system and an updated algorithm. Design: We abstracted structured and unstructured data from electronic medical records on patient demographics, primary indication(s) for hysterectomy, diagnosis codes associated with the hysterectomy, previous treatments, and laboratory results. Subjects: Patients aged 18-44 years. Exposure: Receipt of hysterectomy for benign and nonobstetric conditions from October 2014 to December 2017. Main Outcome Measures: Using these data, we provided a RAND-based (dichotomous: inappropriate/appropriate) and Wright-based (3-level: inappropriate/ambiguous/appropriate) appropriateness rating and characterized missing information patterns associated with inappropriate ratings. Results: We analyzed 1,829 hysterectomies across 30 nonmutually exclusive primary indications for surgery. Nearly a third (32.8%) of surgeries had only one primary indication for surgery. Using the RAND-based classifier, 31.3% of hysterectomies were rated as appropriate and 68.7% as inappropriate. Using the Wright-based algorithm, 58.1% of hysterectomies were rated as appropriate, 15.7% as ambiguous, and 26.2% as inappropriate. Missing information on diagnostic procedures was the most common characteristic related to both RAND-based (46.1%) and Wright-based (51.2%) inappropriate ratings. Conclusions: The 1997 RAND classification lacked guidance for several contemporary indications, including gender-affirming care. RAND also has an outdated requirement for diagnostic surgeries such as laparoscopies, which have decreased in practice as diagnostic imaging has improved. Sensitivity analyses suggest that inappropriate surgeries cannot all be attributed to bias from missing electronic medical record data. Accurately documenting care delivery for benign gynecological conditions is key to ensuring quality and equity in gynecological care.

Duke Scholars

Published In

J Womens Health (Larchmt)

DOI

EISSN

1931-843X

Publication Date

October 2024

Volume

33

Issue

10

Start / End Page

1358 / 1366

Location

United States

Related Subject Headings

  • Young Adult
  • Public Health
  • Hysterectomy
  • Humans
  • Genital Diseases, Female
  • Female
  • Electronic Health Records
  • Algorithms
  • Adult
  • Adolescent
 

Citation

APA
Chicago
ICMJE
MLA
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Wright, M. A., Kinlaw, A. C., McClurg, A. B., Carey, E., Doll, K. M., Vines, A. I., … Robinson, W. R. (2024). Appropriateness of Hysterectomy as Treatment for Benign Gynecological Conditions. J Womens Health (Larchmt), 33(10), 1358–1366. https://doi.org/10.1089/jwh.2024.0142
Wright, Maya A., Alan C. Kinlaw, Asha B. McClurg, Erin Carey, Kemi M. Doll, Anissa I. Vines, Andrew F. Olshan, and Whitney R. Robinson. “Appropriateness of Hysterectomy as Treatment for Benign Gynecological Conditions.J Womens Health (Larchmt) 33, no. 10 (October 2024): 1358–66. https://doi.org/10.1089/jwh.2024.0142.
Wright MA, Kinlaw AC, McClurg AB, Carey E, Doll KM, Vines AI, et al. Appropriateness of Hysterectomy as Treatment for Benign Gynecological Conditions. J Womens Health (Larchmt). 2024 Oct;33(10):1358–66.
Wright, Maya A., et al. “Appropriateness of Hysterectomy as Treatment for Benign Gynecological Conditions.J Womens Health (Larchmt), vol. 33, no. 10, Oct. 2024, pp. 1358–66. Pubmed, doi:10.1089/jwh.2024.0142.
Wright MA, Kinlaw AC, McClurg AB, Carey E, Doll KM, Vines AI, Olshan AF, Robinson WR. Appropriateness of Hysterectomy as Treatment for Benign Gynecological Conditions. J Womens Health (Larchmt). 2024 Oct;33(10):1358–1366.
Journal cover image

Published In

J Womens Health (Larchmt)

DOI

EISSN

1931-843X

Publication Date

October 2024

Volume

33

Issue

10

Start / End Page

1358 / 1366

Location

United States

Related Subject Headings

  • Young Adult
  • Public Health
  • Hysterectomy
  • Humans
  • Genital Diseases, Female
  • Female
  • Electronic Health Records
  • Algorithms
  • Adult
  • Adolescent