Improving quality of care: development of a risk-adjusted perioperative morbidity model for vaginal hysterectomy

Presented at the 29th Annual Scientific Meeting of the American Urogynecologic Society, Chicago, IL, Sept. 4-6, 2008.

Received 26 January 2009; received in revised form 24 April 2009; accepted 24 June 2009. published online 19 August 2009.

Refers to article:

Perioperative maternal morbidity model for vaginal hysterectomy: Heisler et al
Israel Zighelboim, Cindy Zhang, Lindsay Kuroki, Mallika Anand, Summer Dewdney
American Journal of Obstetrics & Gynecology
February 2010 (Vol. 202, Issue 2, Pages 203-204)
Abstract | Full Text | Full-Text PDF (120 KB)

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

a Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN

b Division of Biomedical Informatics and Biostatistics, Mayo Clinic, Rochester, MN

c Divisions of Epidemiology and Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN

Reprints: John B. Gebhart, MD, MS, Division of Gynecologic Surgery, Mayo Clinic, 200 First St. S.W., Rochester, MN 55905

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

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