title: The effectiveness of a multidisciplinary, team-based approach to cesarean hysterectomy in modern obstetric practice.
abstract: OBJECTIVE
  To examine the effectiveness of a multidisciplinary, team-based approach to management of cesarean hysterectomy.
  
  
  METHODS
  In a retrospective chart review, data were analyzed from a quality assurance database of hysterectomies performed after cesarean delivery at one institution in the USA. Patients were identified through billing codes for cesarean delivery, cross-referenced to codes for hysterectomy. Demographic, reproductive, and outcome data were compared before (2000-2005) and after (2011-2013) implementation of a multidisciplinary team-based protocol.
  
  
  RESULTS
  Across the two study periods, 107 cesarean hysterectomies were identified (69 pre-implementation, 38 post-implementation). In univariate analysis, the post-implementation group had fewer days in surgical intensive care than did the pre-implementation group (0.21 ± 0.41 vs 1.04 ± 2.44 days; P=0.011), and a lower frequency of febrile morbidity (4 [11%] vs 22 [32%]; P=0.033]. In multivariate analysis with adjustment for potential confounders, the likelihood of postoperative febrile morbidity was higher during the pre-implementation than the post-implementation period (adjusted odds ratio 3.5, 95% confidence interval 1.09-13.65; P=0.048).
  
  
  CONCLUSIONS
  Outcomes were improved after the multidisciplinary team-based approach to cesarean hysterectomy was implemented. Team-based approaches to care of women undergoing cesarean hysterectomy are important to improve outcomes.
authors.affiliation: School of Allied Health Science, Physician Assistant Program, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Gillespie
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Haleh
authors.initials: H
authors.lastname: Sangi-Haghpeykar
authors.affiliation: Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA.|Harris Health System, Houston, TX, USA.
authors.forename: Uma
authors.initials: U
authors.lastname: Munnur
authors.affiliation: Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA.|Harris Health System, Houston, TX, USA.
authors.forename: Maya S
authors.initials: MS
authors.lastname: Suresh
authors.affiliation: Harris Health System, Houston, TX, USA.
authors.forename: Harold
authors.initials: H
authors.lastname: Miller
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.|Harris Health System, Houston, TX, USA.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Hawkins
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section / Q000379:methods*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007902:Length of Stay; D007744:Obstetric Labor Complications / Q000601:surgery; D009774:Obstetrics / Q000379:methods; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D010921:Placenta Accreta / Q000601:surgery; D049590:Postpartum Period; D011247:Pregnancy; D012189:Retrospective Studies; D055815:Young Adult
keywords: Cesarean delivery; Clinical outcomes; Hysterectomy; Morbidly adherent placenta; Obstetric emergency; Postpartum hemorrhage; Quality improvement