Impact of past surgical history on perioperative outcomes in gynecologic surgery

Impact of past surgical history on perioperative outcomes in gynecologic surgery

We sought to determine if past surgical history is associated with perioperative outcomes for patients undergoing hysterectomy. A retrospective cohort study was conducted at a single, tertiary, academic health system of women who underwent hysterectomy from May 2016 – May 2017. Past surgical history...

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Veröffentlicht in:Gynecologic oncology 2021-04, Vol.161 (1), p.20-24
Hauptverfasser: Ko, Emily M., Aviles, Diego, Koelper, Nathanael C., Morgan, Mark A., Cory, Lori
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creator Ko, Emily M.
Aviles, Diego
Koelper, Nathanael C.
Morgan, Mark A.
Cory, Lori
description We sought to determine if past surgical history is associated with perioperative outcomes for patients undergoing hysterectomy. A retrospective cohort study was conducted at a single, tertiary, academic health system of women who underwent hysterectomy from May 2016 – May 2017. Past surgical history (PSH) involving any abdominal or pelvic surgery, baseline demographics and perioperative outcomes were collected. For purposes of analyses, PSH was defined using three algorithms: 1) any prior abdominopelvic surgery, 2) having had abdominopelvic surgeries likely to cause adhesive disease, 3) anatomic location of prior PSH (none; pelvic; abdominal; or abdominal+pelvic). Descriptive, bivariable and multivariable analyses were performed. 1256 patients underwent hysterectomy. In adjusted analyses, PSH defined by any prior abdominopelvic surgery was associated with length of stay (LOS) (2.1 days (95%CI 1.9, 2.2) vs. 1.8 (95%CI 1.6, 2.0), (p=0.02)). PSH of procedures likely to cause adhesive disease was associated with greater estimated blood loss (EBL) (243.2 mL (95%CI 208.1, 278.3) vs. 189.0 (95%CI 1734, 204.7), (p=0.01)), longer LOS (2.5 days (95%CI 2.2, 2.8) vs. 1.9 (95%CI 1.7, 2.0), (p
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A retrospective cohort study was conducted at a single, tertiary, academic health system of women who underwent hysterectomy from May 2016 – May 2017. Past surgical history (PSH) involving any abdominal or pelvic surgery, baseline demographics and perioperative outcomes were collected. For purposes of analyses, PSH was defined using three algorithms: 1) any prior abdominopelvic surgery, 2) having had abdominopelvic surgeries likely to cause adhesive disease, 3) anatomic location of prior PSH (none; pelvic; abdominal; or abdominal+pelvic). Descriptive, bivariable and multivariable analyses were performed. 1256 patients underwent hysterectomy. In adjusted analyses, PSH defined by any prior abdominopelvic surgery was associated with length of stay (LOS) (2.1 days (95%CI 1.9, 2.2) vs. 1.8 (95%CI 1.6, 2.0), (p=0.02)). PSH of procedures likely to cause adhesive disease was associated with greater estimated blood loss (EBL) (243.2 mL (95%CI 208.1, 278.3) vs. 189.0 (95%CI 1734, 204.7), (p=0.01)), longer LOS (2.5 days (95%CI 2.2, 2.8) vs. 1.9 (95%CI 1.7, 2.0), (p&lt;0.01)), and more readmissions (OR 2.4, 95%CI 1.3, 4.5) (p&lt;0.01). PSH defined by anatomic location revealed a trend (p=0.07) towards greater EBL in those with prior pelvic or abdominal+pelvic surgery compared to none or abdominal only, whereas LOS, readmissions and operative times did not differ. Increased total number of prior open surgeries was associated with operative time (p&lt;0.0001), EBL (p&lt;0.0001), hospital LOS (p&lt;0.0001) and readmission (p=0.026). Prior abdominopelvic surgery is associated with worse perioperative outcome measures in women undergoing hysterectomy. •Past surgical history is associated with perioperative outcomes following hysterectomy.•Different definitions of PSH are variably associated with hysterectomy-based outcomes such as blood loss and readmission.•PSH should be included in risk adjustment strategies when developing value-based care models for hysterectomy.</description><identifier>ISSN: 0090-8258</identifier><identifier>EISSN: 1095-6859</identifier><identifier>DOI: 10.1016/j.ygyno.2020.12.027</identifier><identifier>PMID: 33436286</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><ispartof>Gynecologic oncology, 2021-04, Vol.161 (1), p.20-24</ispartof><rights>2021 Elsevier Inc.</rights><rights>Copyright © 2021 Elsevier Inc. 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A retrospective cohort study was conducted at a single, tertiary, academic health system of women who underwent hysterectomy from May 2016 – May 2017. Past surgical history (PSH) involving any abdominal or pelvic surgery, baseline demographics and perioperative outcomes were collected. For purposes of analyses, PSH was defined using three algorithms: 1) any prior abdominopelvic surgery, 2) having had abdominopelvic surgeries likely to cause adhesive disease, 3) anatomic location of prior PSH (none; pelvic; abdominal; or abdominal+pelvic). Descriptive, bivariable and multivariable analyses were performed. 1256 patients underwent hysterectomy. In adjusted analyses, PSH defined by any prior abdominopelvic surgery was associated with length of stay (LOS) (2.1 days (95%CI 1.9, 2.2) vs. 1.8 (95%CI 1.6, 2.0), (p=0.02)). PSH of procedures likely to cause adhesive disease was associated with greater estimated blood loss (EBL) (243.2 mL (95%CI 208.1, 278.3) vs. 189.0 (95%CI 1734, 204.7), (p=0.01)), longer LOS (2.5 days (95%CI 2.2, 2.8) vs. 1.9 (95%CI 1.7, 2.0), (p&lt;0.01)), and more readmissions (OR 2.4, 95%CI 1.3, 4.5) (p&lt;0.01). PSH defined by anatomic location revealed a trend (p=0.07) towards greater EBL in those with prior pelvic or abdominal+pelvic surgery compared to none or abdominal only, whereas LOS, readmissions and operative times did not differ. Increased total number of prior open surgeries was associated with operative time (p&lt;0.0001), EBL (p&lt;0.0001), hospital LOS (p&lt;0.0001) and readmission (p=0.026). Prior abdominopelvic surgery is associated with worse perioperative outcome measures in women undergoing hysterectomy. •Past surgical history is associated with perioperative outcomes following hysterectomy.•Different definitions of PSH are variably associated with hysterectomy-based outcomes such as blood loss and readmission.•PSH should be included in risk adjustment strategies when developing value-based care models for hysterectomy.</description><issn>0090-8258</issn><issn>1095-6859</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kMtOwzAQRS0EoqXwBUjISzYpEydO4gULhHhUqgQLWFuuMymukjjYSaX8Pe4DlmxsyTp37vgQch3DPIY4u9vMx_XY2jkDFl7YHFh-QqYxCB5lBRenZAogICoYLybkwvsNACQQs3MySZI0yViRTcn7oumU7qmtaKd8T_3g1karmn4Z31s3UtvSDp2x4VC92SK1Q69tg56aloZ-1La2IbJPohsvyVmlao9Xx3tGPp-fPh5fo-Xby-LxYRnphIs-UloXwMuKV8AK0LzKVc6LLNe8LJnWGNZblRArKAVLBSRFHmBYCUwFYykXyYzcHuZ2zn4P6HvZGK-xrlWLdvCSpXnOw2yeBTQ5oNpZ7x1WsnOmUW6UMcidSrmRe5Vyp1LGTAaVIXVzLBhWDZZ_mV93Abg_ABi-uTXopNcGW42lcah7WVrzb8EPs_OHDA</recordid><startdate>202104</startdate><enddate>202104</enddate><creator>Ko, Emily M.</creator><creator>Aviles, Diego</creator><creator>Koelper, Nathanael C.</creator><creator>Morgan, Mark A.</creator><creator>Cory, Lori</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202104</creationdate><title>Impact of past surgical history on perioperative outcomes in gynecologic surgery</title><author>Ko, Emily M. ; Aviles, Diego ; Koelper, Nathanael C. ; Morgan, Mark A. ; Cory, Lori</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c359t-acc805df5f0280c5f7a75867c5dd2cce362bd01a0d924903875df0b9e49224593</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ko, Emily M.</creatorcontrib><creatorcontrib>Aviles, Diego</creatorcontrib><creatorcontrib>Koelper, Nathanael C.</creatorcontrib><creatorcontrib>Morgan, Mark A.</creatorcontrib><creatorcontrib>Cory, Lori</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Gynecologic oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ko, Emily M.</au><au>Aviles, Diego</au><au>Koelper, Nathanael C.</au><au>Morgan, Mark A.</au><au>Cory, Lori</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of past surgical history on perioperative outcomes in gynecologic surgery</atitle><jtitle>Gynecologic oncology</jtitle><addtitle>Gynecol Oncol</addtitle><date>2021-04</date><risdate>2021</risdate><volume>161</volume><issue>1</issue><spage>20</spage><epage>24</epage><pages>20-24</pages><issn>0090-8258</issn><eissn>1095-6859</eissn><abstract>We sought to determine if past surgical history is associated with perioperative outcomes for patients undergoing hysterectomy. A retrospective cohort study was conducted at a single, tertiary, academic health system of women who underwent hysterectomy from May 2016 – May 2017. Past surgical history (PSH) involving any abdominal or pelvic surgery, baseline demographics and perioperative outcomes were collected. For purposes of analyses, PSH was defined using three algorithms: 1) any prior abdominopelvic surgery, 2) having had abdominopelvic surgeries likely to cause adhesive disease, 3) anatomic location of prior PSH (none; pelvic; abdominal; or abdominal+pelvic). Descriptive, bivariable and multivariable analyses were performed. 1256 patients underwent hysterectomy. In adjusted analyses, PSH defined by any prior abdominopelvic surgery was associated with length of stay (LOS) (2.1 days (95%CI 1.9, 2.2) vs. 1.8 (95%CI 1.6, 2.0), (p=0.02)). PSH of procedures likely to cause adhesive disease was associated with greater estimated blood loss (EBL) (243.2 mL (95%CI 208.1, 278.3) vs. 189.0 (95%CI 1734, 204.7), (p=0.01)), longer LOS (2.5 days (95%CI 2.2, 2.8) vs. 1.9 (95%CI 1.7, 2.0), (p&lt;0.01)), and more readmissions (OR 2.4, 95%CI 1.3, 4.5) (p&lt;0.01). PSH defined by anatomic location revealed a trend (p=0.07) towards greater EBL in those with prior pelvic or abdominal+pelvic surgery compared to none or abdominal only, whereas LOS, readmissions and operative times did not differ. Increased total number of prior open surgeries was associated with operative time (p&lt;0.0001), EBL (p&lt;0.0001), hospital LOS (p&lt;0.0001) and readmission (p=0.026). Prior abdominopelvic surgery is associated with worse perioperative outcome measures in women undergoing hysterectomy. •Past surgical history is associated with perioperative outcomes following hysterectomy.•Different definitions of PSH are variably associated with hysterectomy-based outcomes such as blood loss and readmission.•PSH should be included in risk adjustment strategies when developing value-based care models for hysterectomy.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>33436286</pmid><doi>10.1016/j.ygyno.2020.12.027</doi><tpages>5</tpages></addata></record>
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title Impact of past surgical history on perioperative outcomes in gynecologic surgery
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