Readmission After Hysterectomy is Highly Correlated to Reoperation, Morbidity, and Mortality [44]. (May 2015)

• Record Type: Journal Article
• Authors: Catanzarite, Tatiana L.; Vieira, Brittany; Qin, Charles; Kim, John Y.; Milad, Magdy Peter
• Is Part Of: Obstetrics and gynecology. Volume 125(2015)Supplement 1
• Publication Date: 2015-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000465328.72562.fd
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : INTRODUCTION: Although the rates of readmission after hysterectomy have been reported, risk factors and morbidity associated with readmission are not well-defined. METHODS: We identified women undergoing hysterectomy for benign indications between 2011 and 2012 in the American College of Surgeons National Surgical Quality Improvement Program database. Outcomes of interest included rates of 30-day unscheduled readmission, risk factors for readmission, and morbidity and mortality rates associated with readmission. Multivariable logistic regression analyses were performed to identify independent risk factors for readmission. RESULTS: Of the 21, 228 hysterectomies identified, 658 patients (3.1%) required unscheduled readmission within 30 days. Perioperative complications were more likely in patients requiring readmission (49.2% compared with 6.1%, P <.001), most commonly surgical site infection (28.4%) and sepsis (12.8%). Reoperation (26.3% compared with 0.6%, P <.001) and mortality (0.01% compared with 0.3%, P <.001) were markedly increased in patients requiring readmission. After multivariable analysis, independent risk factors for readmission included longer operative time, younger age, smoking, diabetes, dyspnea, bleeding disorders, higher ASA (American Society of Anesthesiologists) level, previous surgery within 30 days of hysterectomy, and longer length of stay. Anesthesia type, resident physician involvement, hysterectomy type, and work relative value units did not independently affect readmission. CONCLUSION: Readmission after hysterectomy was associated with a 40-fold increase in reoperation and 30-fold increase in mortality. Surgeons should counsel patients toward smoking cessation, strive to minimize operative time, and consider delaying nonemergent hysterectomy for benign indications in patients with uncontrolled comorbidities or recent surgery. Future research should aim to further delineate modifiable risk factors for readmission.