Risk Factors for Unscheduled 30-day Readmission after Benign Hysterectomy. Issue 9 (September 2015)

• Record Type: Journal Article
• Authors: Catanzarite, Tatiana; Vieira, Brittany; Qin, Charles; Milad, Magdy P.
• Is Part Of: Southern medical journal. Volume 108:Issue 9(2015)
• Publication Date: 2015-09
• Subjects: gynecologic surgery -- hysterectomy -- perioperative complications -- postoperative readmission; Medicine -- Periodicals; 610.5
• DOI: 10.14423/SMJ.0000000000000341
• Languages: English
• ISSNs: 0038-4348

Abstract

Abstract : Objectives: Readmission rates after hysterectomy have been reported, but specific risk factors for readmission have not been fully delineated. We aimed to determine risk factors for and implications of 30-day unscheduled readmission after benign hysterectomy using data from the American College of Surgeons National Surgical Quality Improvement Program. Methods: We identified benign hysterectomy procedures recorded at all participating National Surgical Quality Improvement Program institutions between 2011 and 2012. Outcomes of interest were 30-day unscheduled readmission rates, variables associated with readmission, and complication and mortality rates associated with readmission. Bivariate analyses were performed using Pearson χ 2 and independent t tests for categorical and continuous variables, respectively. Multivariable regression analysis was performed to identify factors independently associated with readmission. Results: In total, 21, 228 hysterectomies were identified during the study period. Thirty-day readmission rates were 3.8% for abdominal hysterectomy, 2.7% for laparoscopic hysterectomy, 2.9% for laparoscopic-assisted vaginal hysterectomy, and 3.0% for vaginal hysterectomy. Readmission was associated with increased perioperative complications (49.2% vs 6.1%, P < 0.001), return to the operating room (26.3% vs 0.6%, P < 0.001), and mortality (0.3% vs 0.01%, P < 0.001). The most common complications in patients requiring readmission were surgical site infections (28.4%), sepsis (12.8%), urinary tract infection (9.7%), and blood transfusion (6.7%). Variables that were independently associated with 30-day readmission after multivariable regression analysis included younger age (odds ratio [OR] 0.98/year, P < 0.001), smoking (OR 1.28, P = 0.01), diabetes mellitus (OR 1.47, P = 0.008), dyspnea (OR 1.48, P = 0.04), bleeding disorders (OR 1.82, P = 0.04), American Society of Anesthesiologists class ≥3 (OR 1.32, P = 0.009), prior surgery within 30 days (OR 3.60, P = 0.04), longer operative time (OR 1.20 per hour of operative time, P < 0.001), inpatient status (OR 1.36, P = 0.001), and longer length of hospital stay (OR 1.04/day, P < 0.001). Conclusions: Using a large national database, we identified several patient-related and procedural risk factors for unscheduled 30-day readmission after hysterectomy. Readmission was associated with significantly higher rates of complications, a return to the operating room, and a 30-fold increase in mortality. Our findings reinforce the importance of patient selection and optimization of comorbidities before hysterectomy. Future research should aim to further delineate differential risks of readmission by surgical route as well as modifiable risk factors for readmission. Abstract : Readmission rates after hysterectomy have been reported, but specific risk factors have not been fully delineated. This study aimed to identify risk factors for and implications of unscheduled 30-day readmission after benign hysterectomy. Women undergoing hysterectomy for benign disease between 2011 and 2012 were identified within the American College of Surgeons National Surgical Quality Improvement Program database. After multivariable regression analysis, several clinical and procedural variables were found to be associated with unscheduled 30-day readmission. Readmission was associated with significantly higher rates of perioperative complications, returns to the operating room, and mortality.