Volume 202, Issue 2 , Pages 137.e1-137.e5, February 2010
Improving quality of care: development of a risk-adjusted perioperative morbidity model for vaginal hysterectomy
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.
Key words: perioperative morbidity, risk adjustment, vaginal hysterectomy
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Supported in part by research Grant RA-30582 from the National Institutes of Health, US Public Health Service.
Cite this article as: Heisler CA, Aletti GD, Weaver AL, et al. Improving quality of care: development of a risk-adjusted perioperative morbidity model for vaginal hysterectomy. Am J Obstet Gynecol 2010;202:137.e1-5.
PII: S0002-9378(09)00703-0
doi:10.1016/j.ajog.2009.06.059
© 2010 Mosby, Inc. All rights reserved.
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Perioperative maternal morbidity model for vaginal hysterectomy: Heisler et al
Volume 202, Issue 2 , Pages 137.e1-137.e5, February 2010
