Original Article

Does Physician Benchmarking Improve Performance of Laparoscopically Assisted Vaginal Hysterectomy?

Authors: Frank F. Tu, MD, MPH, Joe Feinglass, PHD, Magdy P. Milad, MD, MS

Abstract

Background: Benchmarking techniques were implemented to optimize operating time and charges associated with laparoscopically assisted vaginal hysterectomy (LAVH).


Materials and Methods: The baseline LAVH profile over a period of 4 years (167 cases) was compared with 1-year data (47 cases) after a benchmarking educational program (disseminating data ranking performance by each surgeon plus suggestions for improvement). Preintervention and postintervention profiles were compared by means of Student t test and Wilcoxon rank sum analysis. Hierarchical multiple regression was used to identify additional sources of variation for operative charges and time.


Results: Mean operating times after implementing benchmarking were lower, averaging 182 versus 197 minutes in the control subjects (P = 0.05). We found no significant difference in total or operative charges. After adjusting for potential confounders, benchmarking remained associated with decreased operating time in the multivariate model (P = 0.01).


Conclusions: LAVH operating times decreased after a surgical benchmarking and education intervention, but operating charges did not.


Key Points


* Operating time decreased after implementation of a quality improvement initiative for laparoscopically assisted vaginal hysterectomy.


* Operating costs, adjusted for inflation, did not change after implementation of a quality improvement initiative for laparoscopically assisted vaginal hysterectomy.


* Use of disposable surgical equipment must be balanced against savings in operating room costs to achieve optimal efficiency.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Kovac RS. Guidelines to determine the role of laparoscopically assisted vaginal hysterectomy. Am J Obstet Gynecol 1998;178:1257–1263.
 
2. Figueiredo O, Figueiredo EG, Figueiredo PG, et al. Vaginal removal of the benign nonprolapsed uterus: experience with 300 consecutive operations. Obstet Gynecol 1999;94:348–351.
 
3. Dorsey JH, Holtz PM, Griffiths RI, et al. Costs and charges associated with three alternative techniques of hysterectomy. N Engl J Med 1996;335:476–482.
 
4. Kovac SR. Hysterectomy outcomes in patients with similar indications. Obstet Gynecol2000;95:787–793.
 
5. Summitt Jr, RL Stovall, TG, Lipscomb GH, et al. Randomized comparison of laparoscopy-assisted vaginal hysterectomy with standard vaginal hysterectomy in an outpatient setting. Obstet Gynecol1992;80:895–901.
 
6. Munro MG, Reiter RC, Gambone JC. Technology assessment in women’s health care. Clin Obstet Gynecol 1994;37:180–191.
 
7. Morris M, Gambone JC. Making continual improvements to health care. Clin Obstet Gynecol1994;37:137–148.
 
8. Megler DD, Senn GF. Benchmarking: the key to influencing physicians. Phys Exec 1999:50–55.
 
9. Milad MP, Lindau ST. A comprehensive resident training program in operative endoscopy. Obstet Gynecol 1998;92:148–152.
 
10. US Department of Labor. Consumer Price Index: All Urban Consumers. Available at:http://data.bls.gov/cgi-bin/surveymost. Accessed May 26, 2002.
 
11. Warner MA, Warner DO, Harper CM, et al. Lower extremity neuropathies associated with lithotomy positions. Anesthesiology 2000;93:938–942.
 
12. Mitchell CK, Smoger SH, Pfeifer MP, et al. Multivariate analysis of factors associated with postoperative pulmonary complications following general elective surgery. Arch Surg 1998;133:194–198.
 
13. Boike GM, Elfstrand EP, DelPriore G, et al. Laparoscopically assisted vaginal hysterectomy in a university hospital: report of 82 cases in comparison with abdominal and vaginal hysterectomy. Am J Obstet Gynecol 1993;168:1690–1701.
 
14. Mushinski M. Average charges for three types of hysterectomy procedures: United States, 1998.Stat Bull - Metropolitan Ins Comp 2000;81:27–36.