Morbidity outcomes of 78 577 hysterectomies for benign reasons over 23 years

• Published in: BJOG : an international journal of obstetrics and gynaecology Vol. 115; no. 12; pp. 1473 - 1483
• Main Authors: Spilsbury, K, Hammond, I, Bulsara, M, Semmens, JB
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.11.2008; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Clinical outcomes; Epidemiology; Female; Female Urogenital Diseases - etiology; Genital Diseases, Female - epidemiology; Genital Diseases, Female - surgery; Gynecology; Humans; Hysterectomy; Hysterectomy - adverse effects; Hysterectomy - utilization; Infection - etiology; Length of Stay - statistics & numerical data; Middle Aged; Morbidity; morbidity outcomes; Patient Readmission - statistics & numerical data; Postoperative Hemorrhage - etiology; Pregnancy; Prognosis; record linkage; Residence Characteristics; Retrospective Studies; Western Australia - epidemiology; Young Adult; Western Australia
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/j.1471-0528.2008.01921.x

Objective  To investigate the association of the method of hysterectomy for benign reasons with morbidity outcomes in Western Australia after taking other demographic, social and health‐related factors into account. Design  Population‐based retrospective observational study. Setting  All hospitals in Western Australia where hysterectomies were performed from 1981 to 2003. Population  All women aged 20 years or older who underwent a hysterectomy for benign reasons. Method  Logistic and zero‐truncated negative binomial regression analysis of record‐linked administrative health data. Main outcome measures  Relative odds of experiencing complications during the hysterectomy admission or readmission and relative length of stay in hospital by type of hysterectomy. Results  There were 78 577 hysterectomies performed for benign reasons from 1981 to 2003. Procedure‐related haemorrhage (2.4%) was the most commonly recorded complication, followed by genitourinary disorders (1.9%), infection (1.6%) and urinary tract infections (1.6%). Vaginal hysterectomy was associated with reduced odds of infection and haemorrhage compared with abdominal procedures during the hysterectomy admission. Readmission rates increased from 5.4% in 1981–84 to 7.2% in 2000–03 as average length of stay decreased by 53% over the same time period. Women who underwent laparoscopically assisted vaginal hysterectomies and vaginal hysterectomies had increased odds of readmission for haemorrhage and genitourinary disorders compared with abdominal hysterectomy. Young age, increasing number of co‐morbid conditions and having a complication at hysterectomy admission were also associated with increased odds of readmission. Conclusion  These findings identify women at risk of readmission following hysterectomy and highlight an opportunity to modify early discharge and patient follow‐up practices to reduce this risk.