Improving quality of care: development of a risk-adjusted perioperative morbidity model for vaginal hysterectomy

Christine A. Heisler, Giovanni D. Aletti, Amy L. Weaver, L. Joseph Melton, William Arthur Cliby, John B. Gebhart

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objective: We sought to develop and evaluate a risk-adjusted perioperative morbidity model for vaginal hysterectomy. Study Design: Medical records of women who underwent vaginal hysterectomy during 2004 and 2005 were retrospectively reviewed. Morbidity included hospital readmission, reoperation, and unplanned medical intervention or intensive care unit admission; urinary tract infections were excluded. Multivariate logistic regression identified factors associated with perioperative morbidity (adjusted for urinary tract infection). The resulting model was validated using a random 2006 sample. Results: Of 712 patients, 139 (19.5%) had morbidity associated with congestive heart failure or prior myocardial infarction, perioperative hemoglobin decrease >3.1 g/dL, preoperative hemoglobin <12.0 g/dL, and prior thrombosis (c-index = 0.68). Predicted morbidity was similar to observed rates in the validation sample. Conclusion: History of congestive heart failure or myocardial infarction, prior thrombosis, perioperative hemoglobin decrease >3.1 g/dL, or preoperative hemoglobin <12.0 g/dL were associated with increased perioperative complications. Quality improvement efforts should modify these variables to optimize outcomes.

Original languageEnglish (US)
JournalAmerican Journal of Obstetrics and Gynecology
Volume202
Issue number2
DOIs
StatePublished - Feb 2010

Fingerprint

Vaginal Hysterectomy
Quality of Health Care
Morbidity
Hemoglobins
Urinary Tract Infections
Patient Readmission
Quality Improvement
Reoperation
Medical Records
Intensive Care Units
Heart Failure
Logistic Models
Myocardial Infarction

Keywords

  • perioperative morbidity
  • risk adjustment
  • vaginal hysterectomy

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Improving quality of care : development of a risk-adjusted perioperative morbidity model for vaginal hysterectomy. / Heisler, Christine A.; Aletti, Giovanni D.; Weaver, Amy L.; Melton, L. Joseph; Cliby, William Arthur; Gebhart, John B.

In: American Journal of Obstetrics and Gynecology, Vol. 202, No. 2, 02.2010.

Research output: Contribution to journalArticle

Heisler, Christine A. ; Aletti, Giovanni D. ; Weaver, Amy L. ; Melton, L. Joseph ; Cliby, William Arthur ; Gebhart, John B. / Improving quality of care : development of a risk-adjusted perioperative morbidity model for vaginal hysterectomy. In: American Journal of Obstetrics and Gynecology. 2010 ; Vol. 202, No. 2.
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