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

Autor:	Schmidt PC; Department of Obstetrics and Gynecology, University of Michigan, Ann Abor, Michigan. Electronic address: payton@med.umich.edu., Kamdar NS; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Abor, Michigan., Erekson E; Department of Obstetrics and Gynecology, Dartmouth-Hitchcock, Lebanon, New Hampshire., Swenson CW; Department of Obstetrics and Gynecology, University of Michigan, Ann Abor, Michigan., Uppal S; Department of Obstetrics and Gynecology, University of Michigan, Ann Abor, Michigan., Morgan DM; Department of Obstetrics and Gynecology, University of Michigan, Ann Abor, Michigan.
Jazyk:	angličtina
Zdroj:	Journal of minimally invasive gynecology [J Minim Invasive Gynecol] 2022 Mar; Vol. 29 (3), pp. 401-408.e1. Date of Electronic Publication: 2021 Oct 20.
DOI:	10.1016/j.jmig.2021.10.008
Abstrakt:	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. (Copyright © 2021 AAGL. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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