title: Improving quality of care: development of a risk-adjusted perioperative morbidity model for vaginal hysterectomy.
abstract: 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.
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Heisler
authors.forename: Giovanni D
authors.initials: GD
authors.lastname: Aletti
authors.forename: Amy L
authors.initials: AL
authors.lastname: Weaver
authors.forename: L Joseph
authors.initials: LJ
authors.lastname: Melton
authors.forename: William A
authors.initials: WA
authors.lastname: Cliby
authors.forename: John B
authors.initials: JB
authors.lastname: Gebhart
mesh_terms: 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
chemical_list: D006454:Hemoglobins
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