Cancer, prior abdominal surgery linked to readmission after hysterectomy

1. The overall 30-day admission rate following hysterectomy was 6%.

2. Women with malignancy and prior abdominal surgery were more likely to be readmitted.

Evidence Rating Level: 2 (Good)

Study Rundown: Hysterectomies are one of the most common surgeries in the United States, second only to cesarean deliveries. Indications for hysterectomy include benign diseases like leiomyomas (fibroids), abnormal uterine bleeding, pelvic organ prolapse and pain, as well as malignancy. Hysterectomy can be performed by vaginal, abdominal or laparoscopic surgery. While different surgical approaches and their associated operating times, duration of hospitalization and complication rates have been well studied, less is known about perioperative complications and rehospitalization following hysterectomy. Prior work has suggested that the rate of readmission for hysterectomy is between 3.4% and 12%. Given the current trend in using rehospitalization rates as an indicator of quality and value-based payment, interest has increased in assessing the frequency and clinical characteristics associated with postoperative hospitalizations.

In the present study, the authors assessed risk factors for readmission within 30 days after hysterectomy for both benign and malignant disease. They found that malignancy and prior abdominal surgery were associated with an increased likelihood of readmission after hysterectomy. Strengths of the study were inclusion and stratification of women with benign and malignant disease, as well as evaluation of numerous pre-, intra-, and post- operative risk factors. The study was limited by retrospective design and limited generalizability to medical centers with less experienced surgeons performing hysterectomy. Prospective studies are merited to assess reproducibility and evaluate the predictive value of findings.

Click to read the study in AJOG

Relevant Reading: Factors associated with 30-day hospital readmission after hysterectomy

In-Depth [retrospective cohort]: This study evaluated the incidence of and risk factors for readmission following hysterectomy among 1649 women treated at an academic medical center. The primary outcome of interest was unintended readmission within 30 days after hysterectomy. Preoperative, intraoperative and postoperative variables were also evaluated including patient age, clinical indication, previous abdominal surgeries, surgeon experience, operative duration, estimated blood loss, malignancy on pathology, and length of stay, among others.

The overall 30-day readmission rate was 6%. Among those with benign disease, prior abdominal surgery (OR 2.1, CI 1.1-4.3) was associated with readmission. Women with malignancy were more likely to be rehospitalized (p<0.0001) and in these women, blood loss >500mL (OR 3.3, CI 1.3-8.5), prolonged hospitalization >3 days (OR 16.6, CI 2.9-95.4) and worse physical status (OR 1.9, CI 1.1-3.5) were associated with readmission. Discharge on post-operative day 1 (OR 0.2, CI 0.03-0.8) and laparoscopic route of surgery (OR 0.3, CI 0.1-0.9) were associated with decreased odds of readmission.

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