Design: Multi-center retrospective review of patient-facing TLH educational handouts.

Setting: 19 English-speaking Canadian academic centers.

Patients or Participants: Surgical leads at each center were approached for patient preoperative education materials on TLHs. Resources specific to a condition (e.g. endometriosis) or different hysterectomy route (abdominal/vaginal) were excluded.

Interventions: Not Applicable.

Measurements and Main Results: Handout content was scored based on the presence or absence of 45 recommendations from the American Association of Gynecologic Laparoscopists (AAGL) Enhanced Recovery After Surgery (ERAS) CPG and 5 recommendations from the Society of Obstetricians and Gynaecologists of Canada (SOGC) Hysterectomy CPG. Each handout was independently scored by two assessors to determine if each recommendation was included. A summative score (/50) was assigned. Descriptive statistics and one-sample t-tests were performed to compare scores against an existing AAGL-endorsed TLH handout. Readability was evaluated using an online content analysis software (www.readable.com). Twenty-two TLH resources (21 paper-based, 1 electronic) from 16 hospitals were included. Most centres offered a single resource (median 1, range 1-4) with a mean length of 6.4±9.4 pages. Resources included a median of 18/50 ERAS recommendations (range 8-36/50). Information on comorbidity optimization, infection prophylaxis, and preoperative fasting were communicated in 3(14%), 4(18%) and 5(23%) handouts, respectively. Handouts more commonly reviewed postoperative pain (95%), return to physical activity (91%) and constipation prophylaxis (68%). All resources scored significantly higher than the AAGL-endorsed handout (p<0.001). Mean overall readability was moderate (57.5±11 out of 100).

Conclusion: The quality of resources given to patients prior to TLH is poor and there exists an opportunity for improving patient preoperative patient-facing educational materials.