Biomedical subjects

D Hidlebaugh

Publications and source records attributed to D Hidlebaugh.

7 recordsLinked to original sources

PubMed1997

Clinical and financial analyses of ectopic pregnancy management at a large health plan.

STUDY OBJECTIVE: To compare three treatment options for ectopic pregnancy-laparotomy, laparoscopy, and methotrexate-including clinical aspects, costs, and reproductive outcomes. DESIGN: Retrospective review of outpatient and inpatient records of all patients with a diagnosis of ectopic pregnancy insured by Fallon Community Health from 1990 to 1995. SETTING: Multispecialty group practice and a university-affiliated private hospital. PATIENTS: One hundred seven women treated for ectopic pregnancy. INTERVENTIONS: Thirty-six women were treated by laparotomy, 58 by laparoscopy, and 13 by single-dose intramuscular methotrexate. Data from the chart review were analyzed to define differences among the three groups with respect to several predetermined outcome variables: initial symptoms, risk factors, human chorionic gonadotropin levels, size of ectopic gestation, procedure types, rupture rates, surgical outcomes and morbidity, failure rates, length of convalescence, reproductive outcomes, and costs. MEASUREMENTS AND MAIN RESULTS: The incidence of ectopic pregnancy was 8.6/1000 reported pregnancies. Initially, 38% of surgical patients had laparoscopic treatment, but by 1995 the figure reached 100%. From 1994 to 1995, 13 (29%) of 45 pregnancies were treated with single-dose methotrexate. Compared with laparoscopy, length of stay was significantly longer for laparotomy (3.1 vs 1.3 days), as was recuperation time (2.4 vs 4.6 wks). Laparotomy had similar rates of total complications as laparoscopy (13.9% vs 10.3%). The rate of treatment failures (persistent trophoblastic activity) were 2.7% and 3.4%, respectively. The rate of persistence for laparoscopic salpingostomy was 6.1%. Methotrexate therapy resulted in no tubal ruptures or treatment failures. Two of 13 women required a second injection. The only complication of methotrexate therapy was mild leukocytopenia in one patient. Total charges were similar for laparotomy and laparoscopy ($6720 vs $6840). Outpatient methotrexate therapy cost significantly less than the two surgical procedures (average $818/case, p < 0.001). Laparotomy resulted in similar intrauterine pregnancy rates as laparoscopy (66% vs 77%), and similar repeat tubal pregnancy rates (17% vs 7%). CONCLUSION: The results of this study support laparoscopy and methotrexate as efficacious, safe, and cost effective for the treatment of ectopic pregnancy compared with laparotomy. Reproductive outcomes were similar among the three groups.

Adolescent↗

PubMed1996

A comparison of clinical outcomes and cost of office versus hospital hysteroscopy.

STUDY OBJECTIVE: To compare office hysteroscopy with suction biopsy versus the hospital procedure with respect to clinical outcomes, success rates, and cost. DESIGN: Retrospective review of outpatient and inpatient records for all attempted office hysteroscopies with suction biopsy from September 1991 to June 1995, and all hospital diagnostic hysteroscopies with dilatation curettage from January 1993 to June 1994. SETTING: Multispeciality office group practice and a university-affiliated private hospital. PATIENTS: Four hundred seventy-three women who had office hysteroscopy with suction biopsy and 95 who had hospital diagnostic hysteroscopy with dilatation curettage. INTERVENTIONS: The procedures were performed by 13 gynecologists who had no experience with office hysteroscopy. MEASUREMENTS AND MAIN RESULTS: A cost analysis was completed by obtaining hospital and anesthesia charges for the hospital procedures and comparing them with office, instrument repair, and capital equipment costs. Gynecologists' professional fees were excluded from the analysis since they were the same in both settings. The overall failure rates to complete office and hospital hysteroscopies were 7.2% and 3.1%, respectively. Abnormal uterine bleeding was the indication in 89% of office and 96% of hospital procedures. Office hysteroscopy in these women revealed an abnormality in 40.1% of office versus 38.5% of hospital procedures. Histology revealed insufficient tissue for diagnosis in 3.4% office and 22.1% hospital procedures. The minor complication rate for office hysteroscopy was 1.9% and for hospital hysteroscopy 4.2%. There were no major complications in either group. The mean charges, excluding professional fees, for the hospital were $1799 versus $62 for office hysteroscopy. CONCLUSIONS: Office hysteroscopy has a high success rate and a low complication rate even when performed by a group of gynecologists with limited experience in the procedure. Because of its lower cost and greater diagnostic accuracy, office hysteroscopy with suction biopsy should be the method of choice for evaluating gynecologic conditions such as abnormal bleeding.

Adult↗

PubMed1996

Advances in gynecologic care: the effect on an HMO.

The introduction of four endoscopic surgical procedures into the gynecology department at Fallon Community Health Plan (FCHP) is discussed. The use of these endoscopic procedures reduced average length of stay (ALOS), hospital days/1OOO members, and rate of postoperative complications compared to the open (laparotomy) method. These minimally invasive procedures are popular with patients and physicians, and their use has the potential to decrease an HMO's overall operational costs.

Cost Savings↗

PubMed1995

The initial worcester experience with laparoscopic hysterectomy.

STUDY OBJECTIVE: To examine three community hospital's experience with the first 108 attempted laparoscopic hysterectomies. DESIGN: Retrospective analysis of hospital and office charts using a standardized data-collection sheet. SETTING: All procedures were performed at the Medical Center of Central Massachusetts, St. Vincent's Hospital, or the University of Massachusetts Medical School, Worcester, Massachusetts. PATIENTS: The first 108 patients to have a laparoscopic hysterectomy attempted. Ninety procedures were completed successfully. MEASUREMENTS AND MAIN RESULTS: Areas that were analyzed were indications for surgery, type of laparoscopic hysterectomy, surgeons' instrument preference, failure to complete the operation, complications, and relative cost. Surgical indications, patient demographics, and complication rates were comparable with those unpublished papers. However, our data showed no improvement in estimated blood loss or operating room time with increased operator experience. Review of pathology reports indicated no cases in which an unsuspected malignancy was encountered. CONCLUSIONS: Laparoscopic hysterectomy can be performed safely and successfully by generalists in obstetrics and gynecology. Additional study is required to know whether variables such as operating room time and expense will improve as this procedure is increasingly performed by generalists rather than specialists.

Adult↗

PubMed1994

Clinical and financial analyses of laparoscopically assisted vaginal hysterectomy versus abdominal hysterectomy.

STUDY OBJECTIVE: To perform clinical and financial analyses of laparoscopically assisted vaginal hysterectomy (LAVH) and total abdominal hysterectomy (TAH). DESIGN: During the 16 months between August 1991 and December 1992, 34 women who underwent LAVH were compared with 60 women having TAH during 1990. Indications, surgical outcomes, complications, time to return to work, and hospital charges for each group were analyzed. SETTING: A multispecialty group practice. PATIENTS: The LAVH group included the first 34 cases by the senior author and were the only such procedures at this hospital. The TAH group included all patients having this procedure for benign conditions from the same group practice for 1990. Interventions. Either LAVH or TAH. MEASUREMENTS AND MAIN RESULTS: The most common primary indication in both groups was fibroids. Only one LAVH failed and was converted to a TAH. Postoperative complications were significantly greater for TAH than for LAVH (45% vs 9%). The length of stay and time to return to work were significantly less after LAVH. Total hospital charges increased for LAVH over TAH ($7623 vs $4550) despite a significantly shorter length of stay after LAVH. CONCLUSIONS: Although LAVH has a significantly lower complication rate than TAH, it is more costly to perform. This higher cost, despite a shorter hospital stay, is attributed to high operating room charges. Employers and patients benefit from early return to work with LAVH.

Absenteeism↗

PubMed1994

Laparoscopic Hysterectomy, The Worcester Experience

Despite the enthusiasm in the gynecologic community and the lay press for laparoscopic hysterectomy, there remain few articles to date in the literature supporting this new surgical technique. Those papers that have been published review the laparoscopic hysterectomy experience of the most advanced pelviscopic surgeons. However, the majority of patients inquiring about this surgery are presenting to generalists in obstetrics and gynecology. This paper differs from those previously published in that it examines a community's experience with the first 108 attempted laparoscopic hysterectomies. Areas that were analyzed included indications for surgery, type of laparoscopic hysterectomy, instrument preference, failure to complete operation, complications and relative cost. A retrospective analysis was performed of hospital and office charts using a standardized collection sheet. Laparoscopic-assisted vaginal hysterectomy in which the uterine vessels are controlled vaginally was the most common operative technique used in the Worcester community from August 1991 to December 1992. Surgical indications, patient demographics, and complication rates were comparable with previously published papers. However, our data showed no improvement in estimated blood loss or operating room time with increased operator experience. Pathology reports were reviewed and there were no cases in which an unsuspected malignancy was encountered. This data is presented to evaluate a new surgical procedure and its introduction into the community. In order to reach a consensus on the validity of laparoscopic hysterectomy, continued evaluation will be necessary.

Journal Article↗

PubMed1994

Salpingo-oophorectomy: clinical and financial analyses of laparoscopic and open techniques.

OBJECTIVE: To analyze clinical results and financial costs of salpingo-oophorectomy performed by laparoscopy versus laparotomy. STUDY DESIGN: Comparison of laparoscopic salpingo-oophorectomy with procedures performed by laparotomy. SETTING: St. Vincent's Hospital and Fallon Clinic in Worcester, Massachusetts. PATIENTS: Twenty women in both groups. INTERVENTIONS: Salpingo-oophorectomies performed by laparoscopy and laparotomy. MEASUREMENTS AND MAIN RESULTS: Women undergoing laparotomy had a 25% rate of postoperative complications compared with 0% of those having laparoscopy. The duration of the procedures and hospital charges were similar for both groups. Length of hospital stay and time to return to work were significantly less after laparoscopy than laparotomy. CONCLUSIONS: Laparoscopic salpingo-oophorectomy was associated with significantly fewer complications than the operations performed by laparotomy. Although women in the laparoscopy group had a shorter hospital stay, their higher charges were attributed to costly disposable instruments. Patients benefit from early return to work and other activities after laparoscopy.

Adult↗