Development of a Preoperative Clinical Risk Assessment Tool for Postoperative Complications After Hysterectomy
| Autor: | Shitanshu Uppal, Carolyn W. Swenson, Elisabeth A. Erekson, Neil Kamdar, Daniel M. Morgan, Payton Schmidt |
|---|---|
| Rok vydání: | 2022 |
| Předmět: |
medicine.medical_specialty
Hysterectomy Blood transfusion business.industry medicine.medical_treatment Obstetrics and Gynecology Postoperative complication Odds ratio Nomogram Risk Assessment Article Confidence interval Postoperative Complications Risk Factors Internal medicine Humans Medicine Female business Body mass index Retrospective Studies Abdominal surgery |
| Zdroj: | J Minim Invasive Gynecol |
| ISSN: | 1553-4650 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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