Document Detail

Improving quality of care: development of a risk-adjusted perioperative morbidity model for vaginal hysterectomy.
MedLine Citation:
PMID:  19691949     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: We sought to develop and evaluate a risk-adjusted perioperative morbidity model for vaginal hysterectomy.
STUDY DESIGN: Medical records of women who underwent vaginal hysterectomy during 2004 and 2005 were retrospectively reviewed. Morbidity included hospital readmission, reoperation, and unplanned medical intervention or intensive care unit admission; urinary tract infections were excluded. Multivariate logistic regression identified factors associated with perioperative morbidity (adjusted for urinary tract infection). The resulting model was validated using a random 2006 sample.
RESULTS: Of 712 patients, 139 (19.5%) had morbidity associated with congestive heart failure or prior myocardial infarction, perioperative hemoglobin decrease >3.1 g/dL, preoperative hemoglobin <12.0 g/dL, and prior thrombosis (c-index = 0.68). Predicted morbidity was similar to observed rates in the validation sample.
CONCLUSION: History of congestive heart failure or myocardial infarction, prior thrombosis, perioperative hemoglobin decrease >3.1 g/dL, or preoperative hemoglobin <12.0 g/dL were associated with increased perioperative complications. Quality improvement efforts should modify these variables to optimize outcomes.
Christine A Heisler; Giovanni D Aletti; Amy L Weaver; L Joseph Melton; William A Cliby; John B Gebhart
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.     Date:  2009-08-18
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  202     ISSN:  1097-6868     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-02-01     Completed Date:  2010-02-19     Revised Date:  2014-09-11    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  137.e1-5     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 Mosby, Inc. All rights reserved.
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MeSH Terms
Heart Failure / complications
Hemoglobins / analysis
Hysterectomy, Vaginal / adverse effects*
Logistic Models
Middle Aged
Myocardial Infarction / complications
Quality of Health Care*
Retrospective Studies
Risk Factors
Thrombosis / complications
Grant Support
Reg. No./Substance:
Comment In:
Am J Obstet Gynecol. 2010 Feb;202(2):e1-3   [PMID:  20113684 ]

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