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• W2068688032 abstract "We wish to comment on the article by Dorsey et al. (Dorsey JH, Steinberg EP, Holtz PM. Clinical indications for hysterectomy route: patient characteristics or physicians preference? Am J Obstet Gynecol 1995;173:1452-60). They state, “Although it is easy to criticize the overuse of the abdominal approach, a patient is better served by a surgeon who feels confident and competent with the task at hand than by a surgeon who feels less comfortable with the technique espoused by others.” Evidence-based medicine is being embraced in multiple areas of medical practice. No longer should we blindly accept “clinical expertise” or “comfort” as sufficient justification for using a specific management approach to clinical decision making. The American College of Obstetricians and Gynecologists has recently begun to develop and distribute evidence-based guidelines for its members, as suggested by the U.S. Preventive Services Task Force. The first such guideline evaluated the scientific facts related to the management of women who have previously been delivered by cesarean section.1American College of Obstetricians and Gynecologists Vaginal birth after previous cesarean birth. The College, Washington (DC)1995Google Scholar Because of its proven safety and efficacy, trial of labor has been supported by many third-party payers, preferred provider organizations, and health maintenance organizations. This approach attempts not only to control spiraling health care costs but also to increase corporate profitability. Recently obstetricians have begun to be graded with regard to their clinical performance, cesarean section rate, trial of labor attempts, and successful vaginal births. It is anticipated that insurance plan participation and credentialing will soon be based on some of these factors. The time has now come for a similar awakening in the field of gynecology. The “ostrich” approach to the nonacceptance of reproducible scientific data must be changed. A successfully completed hysterectomy in and of itself does not reflect appropriate management. Because there are measurable differences in medical and economic outcomes for abdominal, vaginal, and laparoscopic hysterectomy, good surgical practice dictates that the severity of the pathologic disorder be used as the primary criterion for selecting the route of hysterectomy, not subjective factors such as the surgeon's experience or preference. An individual physician's increased comfort with the abdominal or laparoscopic approach should not be sufficient to preclude a vaginal approach. Traditionally, the number of hysterectomies performed by the various routes have occurred without the application of systematic guidelines. Where such guidelines have been put into practice in the United States,2Kovac SR Guidelines to determine the route of hysterectomy.Obstet Gynecol. 1995; 85: 18-23Crossref PubMed Scopus (220) Google Scholar France,3Querleu D Cosson M Parmentier D DeBondinance P The impact of laparoscopic surgery on vaginal hysterectomy.Gynecol Endosc. 1993; 2: 89-91Google Scholar and the United Kingdom,4Richardson RE Bournas N Magos AL Is laparoscopic hysterectomy a waste of time?.Lancet. 1995; 345: 36-41Abstract PubMed Scopus (204) Google Scholar it was found that most patients could safely and successfully undergo vaginal hysterectomy. If such guidelines were applied nationally, their impact would be to largely replace abdominal hysterectomy, not with laparoscopically assisted vaginal hysterectomy but with vaginal hysterectomy, at tremendous health care savings. These guidelines are more than just suggestions; they are evidence based. We would not be surprised if in the near future clinical credentialing will include an evaluation of the surgical approach to hysterectomy in a manner similar to credentialing associated with obstetric care. Has not the time arrived where the science and facts applicable to gynecologic surgery should be embraced and used to improve ultimate patient outcome? 6/8/74260" @default.
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• W2068688032 title "Evidence-based practice in obstetrics and gynecology: Its time has come" @default.
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• W2068688032 doi "https://doi.org/10.1016/s0002-9378(96)70286-7" @default.
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