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.


METHODS
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.


CONCLUSIONS
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.
Heisler
Christine A
CA
Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA.
Aletti
Giovanni D
GD
Weaver
Amy L
AL
Melton
L Joseph
LJ
Cliby
William A
WA
Gebhart
John B
JB
D000328:Adult; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000150:complications; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects*; D016015:Logistic Models; D008875:Middle Aged; D009017:Morbidity; D009203:Myocardial Infarction / Q000150:complications; D011787:Quality of Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000150:complications
D006454:Hemoglobins
Am J Obstet Gynecol. 2000 Dec;183(6):1355-8; discussion 1359-60
11120496
Hum Reprod. 2001 Jul;16(7):1473-8
11425832
Gynecol Oncol. 2007 Oct;107(1):99-106
17602726
Stat Med. 1996 Feb 28;15(4):361-87
8668867
J Am Coll Surg. 2007 Jun;204(6):1293-300
17544087
Am Surg. 2006 Nov;72(11):994-8; discussion 1021-30, 1133-48
17120939
Yonsei Med J. 2004 Apr 30;45(2):281-6
15119000