Complication rates between local and referral patients undergoing vaginal hysterectomy at an academic medical center

OBJECTIVE: To explore the influence of referral bias on complication rates after vaginal hysterectomy. PATIENTS AND METHODS: Community-based (local) and referral patients had benign indications and underwent vaginal hysterectomy from January 1, 2004, through December 31, 2005. We retrospectively evaluated patient characteristics, surgical procedures, and complications that occurred within 9 weeks after the index surgery. Complications were defined as admission to the intensive care unit, reoperation, hospital readmission, or medical intervention. RESULTS: Of 736 patients, 361 (49.0%) were referred from outside the immediate 7-county area. Compared with local patients, referral patients were older (mean age, 54.5 vs 49.3 years; P<.001) and had lower body mass index (mean, 27.6 vs 28.7 kg/m²; P=.02). More referral patients had cardiovascular disease (4.2% vs 0.5%; P=.001) and prior myocardial infarctions (1.9% vs 0%; P=.007). Referral patients also had higher American Society of Anesthesiologists scores (score of 3 or 4, 12.6% vs 7.0%; P=.01) and longer length of hospitalization (mean, 2.6 vs 2.2 days; P<.001), and more underwent pelvic reconstruction (52.1% vs 41.3%; P=.004). Fewer referral patients had private insurance (74.5% vs 89.6%; P<.001). Despite these differences, overall complication rates were similar for referral and local patients (33.4% vs 29.7%; P=.28). CONCLUSION: Although referral patients had more comorbid conditions than local patients, the groups had similar complication rates after vaginal hysterectomy.