Development of a Preoperative Clinical Risk Assessment Tool for Postoperative Complications After Hysterectomy.

Abstract Study Objective To develop a preoperative risk assessment tool that quantifies the risk of postoperative complications within 30 days of hysterectomy. Design Retrospective analysis. Setting Michigan Surgical Quality Collaborative hospitals. Patients Women who underwent hysterectomy for gynecologic indications. Interventions Development of a nomogram to create a clinical risk assessment tool. Measurements and Main Results Postoperative complications within 30 days were the primary outcome. Bivariate analysis was performed comparing women who did and did not have a complication. The patient registry was randomly divided. A logistic regression model developed and validated from the Collaborative database was externally validated with hysterectomy cases from the National Surgical Quality Improvement Program and a nomogram was developed to create a clinical risk assessment tool. Of the 41,147 included women, the overall postoperative complication rate was 3.98% (n=1,638). Preoperative factors associated with postoperative complications were sepsis (OR 7.98, CI 1.98-32.20); abdominal approach (OR 2.27, CI 1.70-3.05); dependent functional status (OR 2.20, CI 1.34-3.62); bleeding disorder (OR 2.10, CI 1.37-3.21); diabetes mellitus with HbA1c ≥9% (OR 1.93, CI 1.16-3.24); gynecologic cancer (OR 1.86, CI 1.49-2.31); blood transfusion (OR 1.84, CI 1.15-2.96); American Society of Anesthesiologists Physical Status Classification System class ≥3 (OR 1.46, CI 1.24-1.73); government insurance (OR 1.3, CI 1.40-1.90); and Body Mass Index ≥40 (OR 1.25, CI 1.04-1.50). Model discrimination was consistent in the derivation, internal validation, and external validation cohorts (C-statistics 0.68, 0.69, 0.68, respectively). Conclusion We validated a preoperative clinical risk assessment tool to predict postoperative complications within 30 days of hysterectomy. Modifiable risk factors identified were preoperative blood transfusion, poor glycemic control, and open abdominal surgery.