Retrospective Cohort Study of Low-Value Hysterectomy Before and After Publication of the National Heavy Bleeding Clinical Care Standard in Regional Victoria

Objective

To evaluate the prevalence of low-value care hysterectomy before and after publication of the National Heavy Menstrual Bleeding Clinical Care Standard (HMB Standard) in a regional Victorian hospital. The secondary aim was to assess whether compliance with the HMB Standard improved.

Methods

Retrospective cohort design. All patients booked for a planned benign hysterectomy were included. Manual chart review was undertaken for demographics, surgical planning, procedure, and outcomes to 28 days.

Design Setting

A single regional Victorian hospital within an area identified to be high volume for benign hysterectomy.

Participants

Patients who planned benign hysterectomy in the 10 months prior (Group 1—Control) and 10 months after (Group 2—Post-intervention) publication of the HMB Standard in October 2017.

Main Outcome Measures

Low-value hysterectomy was defined as the proportion of benign hysterectomies performed via the abdominal route in the absence of cancer or a previous caesarean section.

Results

There were 64 patients in Group 1 and 60 in Group 2 included. Low-value hysterectomy proportion had a non-significant change from 9.4% in Group 1 to 11.7% in Group 2, 95% confidence interval = [−0.1303, 0.0857]. Compliance to the HMB Standard had mixed results.

Conclusions

There was no clinically significant change in low-value hysterectomy in the 10 months following publication of the HMB Standard, compared to 10 months prior, in a regional Victorian hospital. Uptake of therapeutic alternatives to hysterectomy was low.