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Development of a Preoperative Clinical Risk Assessment Tool for Postoperative Complications After Hysterectomy

Published:October 19, 2021DOI:https://doi.org/10.1016/j.jmig.2021.10.008

      ABSTRACT

      Study Objective

      To develop a preoperative risk assessment tool that quantifies the risk of postoperative complications within 30 days of hysterectomy.

      Design

      Retrospective analysis.

      Setting

      Michigan Surgical Quality Collaborative hospitals.

      Patients

      Women who underwent hysterectomy for gynecologic indications.

      Interventions

      Development of a nomogram to create a clinical risk assessment tool.

      Measurements and Main Results

      Postoperative complications within 30 days were the primary outcome. Bivariate analysis was performed comparing women who had a complication and those who did not. The patient registry was randomly divided. A logistic regression model developed and validated from the Collaborative database was externally validated with hysterectomy cases from the National Surgical Quality Improvement Program, and a nomogram was developed to create a clinical risk assessment tool. Of the 41,147 included women, the overall postoperative complication rate was 3.98% (n = 1638). Preoperative factors associated with postoperative complications were sepsis (odds ratio [OR] 7.98; confidence interval [CI], 1.98–32.20), abdominal approach (OR 2.27; 95% CI, 1.70–3.05), dependent functional status (OR 2.20; 95% CI, 1.34–3.62), bleeding disorder (OR 2.10; 95% CI, 1.37–3.21), diabetes with HbA1c ≥9% (OR 1.93; 95% CI, 1.16–3.24), gynecologic cancer (OR 1.86; 95% CI, 1.49–2.31), blood transfusion (OR 1.84; 95% CI, 1.15–2.96), American Society of Anesthesiologists Physical Status Classification System class ≥3 (OR 1.46; 95% CI, 1.24–1.73), government insurance (OR 1.3; 95% CI, 1.40–1.90), and body mass index ≥40 (OR 1.25; 95% CI, 1.04–1.50). Model discrimination was consistent in the derivation, internal validation, and external validation cohorts (C-statistics 0.68, 0.69, 0.68, respectively).

      Conclusion

      We validated a preoperative clinical risk assessment tool to predict postoperative complications within 30 days of hysterectomy. Modifiable risk factors identified were preoperative blood transfusion, poor glycemic control, and open abdominal surgery.

      Keywords

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