Study objectives: The primary objective of this study is to identify patient characteristics associated with postoperative complications or readmissions following hysterectomy for a benign indication.
Design: Retrospective cohort
Setting: The Surgical Gynecology Scorecard Database (SGSD) includes performance measures and patient outcomes for hysterectomies at 7 sites in Ontario, Canada.
The patients: People who underwent a hysterectomy for benign gynecological indication and registered in the SGSD between July 2016 and June 2019 were included in this study.
Measurements: Two outcomes of interest were considered, (1) complications grade II or higher on the Clavien-Dindo grading scale and (2) emergency room visits or hospital readmissions in the 6 weeks after the operation. Logistic models were generated to determine associations between the outcome of interest and potential predictors using a mixed-stage AIC selection algorithm.
Principle results: 2792 patients underwent hysterectomy for a benign indication during the study period with an average age of 52.6±11.7 years and an average BMI of 29.0±6.7 kg/m2. The most common surgical indications were abnormal uterine bleeding (33.3%) and fibroids (33.6%). Previous caesarean section (aOR 1.22; 95% CI 1.04-1.42), ASA class ≥ 3 (2.31; 1.42-3.99), preoperative anemia (1.51; 1 ,12-2.02) and a laparotomy approach (1.73; 1.30-2.29) were associated with an increased risk of complications. Perioperative complications (2.95; 2.12-4.08), preoperative anemia (1.43; 1.03-1.98) and vaginal approach (1.94; 126-2.96) or laparotomy (1.64; 1.10-2.43) were associated with an increased likelihood of emergency department visit or hospital readmission.
Conclusion: This study identified several important risk factors for complications after hysterectomy. The utility of these data is significant in helping to improve counseling for patients undergoing hysterectomy and potentially optimizing altered risk factors when identified preoperatively.
Accepted: April 26, 2022
Received in revised form: March 31, 2022
Received: February 2, 2022
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Disclosures: AM is a member of the speakers bureaus and advisory boards for AbbVie, Allergan, Bayer and Hologic and a member of the speakers bureau for Medtronic. OB reports grants from Bayer and Allergan and personal fees from Bayer, AbbVie and Hologic. All funding and declared interests of the authors are outside of the submitted work. The other authors declare no conflicts of interest. All authors have indicated that they meet the journal’s authorship requirements.
Funding: Financial support for this research was provided by the Department of Obstetrics and Gynecology at Queen’s University, the Department of Obstetrics and Gynecology at Mount Sinai Hospital and the University of Toronto, the innovation from the Mount Sinai Hospital Academic Medical Organization and the Kavelman-Fonn Foundation Grant from the Sinai Health Foundation. The sponsors had no role in the design of the study, the collection/analysis/interpretation of the data, the writing of the manuscript, or the decision to submit it for publication.
Preliminary presentation: This work was presented in part at the Canadian Society for Advancement of Excellence in Gynecology 2021 Annual Meeting.
Ethical clearance: This study has been reviewed for ethical compliance by the Health Sciences Research Ethics Board of Queen’s University and Affiliated Teaching Hospitals (OBGY-336-18, initial clearance October 25and2018) and Mount Sinai Hospital Research Ethics Board (17-0148-E, initial clearance July 24and2017).
Data availability: Requests for access to data collected as part of the Surgical Gynecology Scorecard Database should be directed to LS and AM. Ethical clearance and appropriate data agreements are required.
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