Hysterectomy for benign conditions: Complications relative to surgical approach and other variables that lead to post-operative readmission within 90 days of surgery.
Hysterectomy for benign conditions: Complications relative to surgical approach and other variables that lead to post-operative readmission within 90 days of surgery.
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DOI：
10.1177/1745505717714657
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发表时间：
2017-08
期刊：
影响因子：
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通讯作者：
Hudson SM
中科院分区：
文献类型：
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作者：
Lonky NM;Mohan Y;Chiu VY;Park J;Kivnick S;Hong C;Hudson SM
检查与直肠癌切除术相关并发症相关的变量，相对于手术方法和其他变量，导致手术后90天内再次入院。我们进行了一项观察性队列研究，其数据来自电子健康记录。提取2010年6月至2011年9月期间在10家Kaiser Permanente Southern加州医疗中心接受直肠切除术的所有患者（n = 3106）的数据。怀孕或患有癌症的患者被排除在研究之外。为了确定检查变量和手术类型之间的单变量相关性，对分类变量进行卡方检验，对连续变量进行t检验或方差分析。广义估计方程方法用于检验自变量和主要关注结果之间的关联。使用p值<.05确定统计学显著性。在3106例患者中，109例发生了168例术后并发症。最常见的术后并发症与盆腔脓肿、肠梗阻或严重肠梗阻以及阴道断端有关。盆腔脓肿在腹腔镜全子宫切除术和腹式全子宫切除术病例中最常见（p = .002），阴道断端并发症在腹腔镜全子宫切除术病例中最常见（p = .015）。接受阴式全子宫切除术的患者（比值比= 2.13，置信区间= 1.15-3.92），腹腔镜宫颈上子宫切除术（比值比= 3.11，置信区间= 1.13-8.57），腹腔镜全子宫切除术（比值比= 5.60，置信区间= 2.90-10.79）的患者术后并发症发生率增加，导致再次入院。与再入院风险增加相关的其他变量包括高估计失血量（201-300 mL和301+ mL，相对于0-50 mL;比值比= 2.28，置信区间= 1.24-4.18和比值比= 2.63，置信区间= 1.67-4.14）和3天或以上的长期住院时间（相对于0天;比值比= 2.93，置信区间= 1.28-6.69）。骨盆标本重量在151-300 g和501+ g范围内具有保护作用（比值比= 0.40，置信区间= 0.25-0.64和比值比= 0.54，置信区间= 0.33-0.90）。在对1294例患者的亚组分析中，在59例患者中确定了74例与子宫切除术直接相关的医院手术并发症。最常见的医院手术并发症是与手术相关的大量出血或附近结构损伤。在1294名患者的子样本中，患有医院手术并发症的患者更有可能出现导致再次入院的术后并发症（比值比= 3.82，置信区间= 1.55-9.43，p = 0.004）。在黑人患者中观察到的并发症风险增加，这些患者接受了腹腔镜子宫切除术或全腹腔镜子宫切除术，手术失血超过300 mL，发生了医院手术并发症，以及住院时间≥ 3天，为常规子宫切除术护理提供了更高的审查和预防措施，以防止以后再次入院。
To examine variables associated with hysterectomy-related complications, relative to surgical approach and other variables, that lead to readmission within 90 days of surgery. We conducted an observational cohort study for which data were extracted from electronic health records. Data were extracted of all patients (n = 3106) who underwent hysterectomies at 10 Kaiser Permanente Southern California medical centers between June 2010 and September 2011. Patients who were pregnant or had a cancer diagnosis were excluded from the study. To identify univariate associations between examined variables and procedure type, chi-square tests for categorical variables and t-tests or analysis of variance for continuous variables were used. Generalized estimating equations methods were used to test associations between independent variables and primary outcomes of interest. Statistical significance was determined using a p-value <.05. Of 3106 patients, 109 experienced 168 post-operative complications. The most common post-operative complications were related to pelvic abscesses, bowel obstruction, or severe ileus, and the vaginal cuff. Pelvic abscesses were most frequent among total laparoscopic hysterectomy and total abdominal hysterectomy cases (p = .002), and vaginal cuff complications were most frequent among total laparoscopic hysterectomy cases (p = .015). Patients who underwent total vaginal hysterectomy (odds ratio = 2.13, confidence interval = 1.15–3.92), laparoscopic supracervical hysterectomy (odds ratio = 3.11, confidence interval = 1.13–8.57), and total laparoscopic hysterectomy (odds ratio = 5.60, confidence interval = 2.90–10.79) experienced increased occurrence of post-operative complications resulting in readmission. Other variables associated with an increased risk for readmission included high estimated blood loss (201–300 mL and 301+ mL, relative to 0–50 mL; odds ratio = 2.28, confidence interval = 1.24–4.18 and odds ratio = 2.63, confidence interval = 1.67–4.14) and long length of stay of 3 days or more (relative to 0 days; odds ratio = 2.93, confidence interval = 1.28–6.69). Pelvic specimen weight in the 151–300 g and 501+ g ranges appeared protective (odds ratio = 0.40, confidence interval = 0.25–0.64 and odds ratio = 0.54, confidence interval = 0.33–0.90). In a sub-analysis of 1294 patients, 74 hospital operative complications directly related to hysterectomy were identified among 59 patients. The most common hospital operative complications were excessive bleeding associated with surgery or injury to nearby structures. Among the sub-sample of 1294 patients, those with hospital operative complications were more likely to experience post-operative complications that lead to readmission (odds ratio = 3.82, confidence interval = 1.55–9.43, p = .004). The observed increased risk of complications among patients of Black race, who underwent laparoscopic supracervical hysterectomy or total laparoscopic hysterectomy, who experienced more than 300 mL surgical blood loss, who suffered hospital operative complications, and those whose hospitalization was 3 days or greater, offers an opportunity for higher scrutiny and preventive measures during usual hysterectomy care to prevent later readmission.