J Minim Invasive Gynecol. 2021 Oct 20:S1553-4650(21)01224-3. doi: 10.1016/j.jmig.2021.10.008. Online ahead of print.
ABSTRACT
STUDY OBJECTIVE: To develop a preoperative risk assessment tool that quantifies the risk of postoperative complications within 30 days of hysterectomy.
DESIGN: Retrospective analysis.
SETTING: Michigan Surgical Quality Collaborative hospitals.
PATIENTS: Women who underwent hysterectomy for gynecologic indications.
INTERVENTIONS: Development of a nomogram to create a clinical risk assessment tool.
MEASUREMENTS AND MAIN RESULTS: Postoperative complications within 30 days were the primary outcome. Bivariate analysis was performed comparing women who did and did not have a complication. The patient registry was randomly divided. A logistic regression model developed and validated from the Collaborative database was externally validated with hysterectomy cases from the National Surgical Quality Improvement Program and a nomogram was developed to create a clinical risk assessment tool. Of the 41,147 included women, the overall postoperative complication rate was 3.98% (n=1,638). Preoperative factors associated with postoperative complications were sepsis (OR 7.98, CI 1.98-32.20); abdominal approach (OR 2.27, CI 1.70-3.05); dependent functional status (OR 2.20, CI 1.34-3.62); bleeding disorder (OR 2.10, CI 1.37-3.21); diabetes mellitus with HbA1c ≥9% (OR 1.93, CI 1.16-3.24); gynecologic cancer (OR 1.86, CI 1.49-2.31); blood transfusion (OR 1.84, CI 1.15-2.96); American Society of Anesthesiologists Physical Status Classification System class ≥3 (OR 1.46, CI 1.24-1.73); government insurance (OR 1.3, CI 1.40-1.90); and Body Mass Index ≥40 (OR 1.25, CI 1.04-1.50). Model discrimination was consistent in the derivation, internal validation, and external validation cohorts (C-statistics 0.68, 0.69, 0.68, respectively).
CONCLUSION: We validated a preoperative clinical risk assessment tool to predict postoperative complications within 30 days of hysterectomy. Modifiable risk factors identified were preoperative blood transfusion, poor glycemic control, and open abdominal surgery.
PMID:34687927 | DOI:10.1016/j.jmig.2021.10.008
