title: Complication rates between local and referral patients undergoing vaginal hysterectomy at an academic medical center.
abstract: OBJECTIVE
  To explore the influence of referral bias on complication rates after vaginal hysterectomy.
  
  
  METHODS
  Community-based (local) and referral patients had benign indications and underwent vaginal hysterectomy from January 1, 2004, through December 31, 2005. We retrospectively evaluated patient characteristics, surgical procedures, and complications that occurred within 9 weeks after the index surgery. Complications were defined as admission to the intensive care unit, reoperation, hospital readmission, or medical intervention.
  
  
  RESULTS
  Of 736 patients, 361 (49.0%) were referred from outside the immediate 7-county area. Compared with local patients, referral patients were older (mean age, 54.5 vs 49.3 years; P<.001) and had lower body mass index (mean, 27.6 vs 28.7 kg/m2; P=.02). More referral patients had cardiovascular disease (4.2% vs 0.5%; P=.001) and prior myocardial infarctions (1.9% vs 0%; P=.007). Referral patients also had higher American Society of Anesthesiologists scores (score of 3 or 4, 12.6% vs 7.0%; P=.01) and longer length of hospitalization (mean, 2.6 vs 2.2 days; P<.001), and more underwent pelvic reconstruction (52.1% vs 41.3%; P=.004). Fewer referral patients had private insurance (74.5% vs 89.6%; P<.001). Despite these differences, overall complication rates were similar for referral and local patients (33.4% vs 29.7%; P=.28).
  
  
  CONCLUSIONS
  Although referral patients had more comorbid conditions than local patients, the groups had similar complication rates after vaginal hysterectomy.
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Heisler
authors.forename: L Joseph
authors.initials: LJ
authors.lastname: Melton
authors.forename: Amy L
authors.initials: AL
authors.lastname: Weaver
authors.forename: John B
authors.initials: JB
authors.lastname: Gebhart
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000367:Age Factors; D015982:Bias; D015992:Body Mass Index; D015897:Comorbidity; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects* / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D010359:Patient Readmission / Q000706:statistics & numerical data; D018579:Patient Selection; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome