title: Risk factors for febrile morbidity after hysterectomy.
abstract: OBJECTIVE
  To identify risk factors for febrile morbidity after hysterectomy for nonmalignant indications.
  
  
  METHODS
  We performed a retrospective cohort study of 686 women who had a hysterectomy between January and September 1997 by abdominal (n = 408), laparoscopic-assisted vaginal (n = 90), or vaginal (n = 188) approaches. Potential risk factors for febrile morbidity were extracted from the medical records. By means of multivariable logistic regression, we evaluated demographic, reproductive, clinical, and operative risk factors for febrile morbidity.
  
  
  RESULTS
  The risk of postoperative febrile morbidity in this population was 14%. Only 50% of women received prophylactic antibiotics, whereas almost 20% received no antibiotics at all, and 30% were administered antibiotics after surgical incision. Risk factors for febrile morbidity after hysterectomy, after controlling for age, body mass index, operative time, and prophylactic antibiotic administration, were abdominal approach (odds ratio 2.7; 95% confidence interval 1.6, 4.3) and blood loss at surgery of more than 750 mL (odds ratio 3.5; 95% confidence interval 1.8, 6.8).
  
  
  CONCLUSIONS
  Hysterectomy by abdominal approach and increased blood loss at the time of surgery significantly increase the risk of febrile morbidity. Preventive efforts should focus on methods to reduce postoperative febrile morbidity, including meticulous surgical technique and routine use and appropriate timing of prophylactic antibiotic therapy.
authors.affiliation: Department of Obstetrics and Gynecology and Community Health, Brown University Medical School, Women & Infants Hospital, Providence, Rhode Island 02905, USA. jpeipert@wihri.org
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Peipert
authors.forename: Sherry
authors.initials: S
authors.lastname: Weitzen
authors.forename: Courtney
authors.initials: C
authors.lastname: Cruickshank
authors.forename: Errett
authors.initials: E
authors.lastname: Story
authors.forename: Daniel
authors.initials: D
authors.lastname: Ethridge
authors.forename: Kate
authors.initials: K
authors.lastname: Lapane
mesh_terms: D000328:Adult; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D005260:Female; D005334:Fever / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects*; D007045:Hysterectomy, Vaginal / Q000009:adverse effects; D008499:Medical Records; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D011300:Preoperative Care / Q000592:standards; D012189:Retrospective Studies; D012237:Rhode Island / Q000453:epidemiology; D012307:Risk Factors; D016896:Treatment Outcome