Measuring the Quality of Care at the Cedars-Sinai Center for Minimally Invasive Gynecologic Surgery

Physicians in the Center for Minimally Invasive Gynecologic Surgery have combined surgical volume with state of the art technology to safely perform complex procedures like hysterectomies.

Comparing Hysterectomy Rates Performed Laparoscopically and Using a Traditional Open Approach at the Cedars-Sinai Center for Minimally Invasive Gynecologic Surgery

In a study examining the three surgical approaches to performing a hysterectomy (abdominal, vaginal or laparoscopic), the benefits of the minimally invasive laparoscopic approach compared to the abdominal approach included speedier return to normal activities, less bleeding during surgery, shorter hospital stay and fewer infections. 1, 2

From a cross-sectional analysis of the 2011 Nationwide Inpatient Sample3, among 342,111 hysterectomies, 31.7% were performed laparoscopically, 50.1% abdominally (or open), and 18.2% vaginally. As detailed in the table below, Cedars-Sinai’s CMIGS physicians have performed these cutting-edge laparoscopic hysterectomies at more than double the national average.

 

Cedars-Sinai Center for Minimally Invasive Gynecologic Surgery 

  U.S. AverageCedars-Sinai
Percentage of Hysterectomies Performed for Benign Conditions:2011July 1, 2010 - June 30, 2011July 1, 2011- June 30, 2012July 1, 2012 - June 30, 2013
Laparoscopically31.7%45.7%53.0%52.9%
Abdominally50.1%49.4%39.9%35.1%
Vaginally18.2%4.9%7.1%12.0%

 

1 Nieboer TE, Johnson N, Lethaby A, et al. Surgical approach to hysterectomy for benign gynaecological disease. Obstetrics and Gynaecology, 2009 Jul 8;(3):CD003677.
2 ACOG Committee Opinion  No. 444: choosing the route of hysterectomy for benign disease. Obstet Gynecol, 2009 Nov;114(5):1156-8.
3 HCUP Nationwide Inpatient Sample (NIS), 2011, Agency for Healthcare Research and Quality (AHRQ), based on data collected by individual states and provided to AHRQ by the states.  

Volume and Average Length of Stay for Hysterectomy Patients Treated at the Cedars-Sinai Center for Minimally Invasive Gynecologic Surgery

This quality measure refers to the average number of days a patient stays at Cedars-Sinai Medical Center after being admitted for a hysterectomy. The goal is to ensure that all patients are appropriately treated in the hospital for their respective conditions and are not hospitalized longer than necessary. Studies show that patients who spend less time in the hospital after surgery will have fewer complications.4,5,6

As detailed in the chart below, laparoscopic hysterectomies performed by Cedars-Sinai's CMIGS physicians resulted in a consistently shorter length of stay, currently less than the national average.
 

Procedure Volumes and Average Length of Stay at the Cedars-Sinai Center for Minimally Invasive Surgery from July 1, 2012 to June 30, 2013:

Volume

Average Length of Stay (In Days)

72013 Year to Date UHC Average Length of Stay

 (In Days)

Laparoscopic Hysterectomies

101

1.19

1.61

Abdominal Hysterectomies

67

3.52

3.69

Vaginal Hysterectomies

23

1.48

1.55

Total

181

  


4 Rotter T, Kinsman L, James E, et al. Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs. Department of Public Health, Dresden Medical School, University of Dresden, Dresden, Germany, D-01307, 2010 Mar 17;3:CD006632.
5 Becker ER. National trends and determinants of hospitalization costs and lengths-of-stay for uterine fibroids procedures. J Health Care Finance, 2007 Spring; 33(3):1-16.
6 Pearson SD, Kleefield SF, Soukop JR, et al. Critical pathways intervention to reduce length of hospital stay. Am J Med, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care; and the Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA, 2001 Feb 15;110(3):175-80.
7 The UHC is an alliance of 120 academic medical centers and 299 of their affiliated hospitals representing approximately 90% of the nation's non-profit academic medical centers; most of these facilities participate in the Clinical DataBase/Resource Manager.  The data  was accessed on November 11, 2013.  Patient populations are defined as follows:  laparoscopic = ICD-9 primary procedure 68.31, 68.41, or 68.51; abdominal/open = ICD-9 primary procedure 68.39, 68.49, or 68.9; and vaginal procedures are those with primary procedure code 68.59.  Cases with malignancy as defined by DRG 742 or 742 are excluded.