Are perioperative bundles associated with reduced postoperative morbidity in women undergoing benign hysterectomy? Retrospective cohort analysis of 16,286 cases in Michigan

Background Healthcare teams that frequently follow a bundle of evidence-based processes provide care with lower rates of morbidity. Few process bundles to improve surgical outcomes in hysterectomy have been identified. Objective The purpose of this study was to investigate whether a bundle of 4 peri...

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Published in:American journal of obstetrics and gynecology 2017-05, Vol.216 (5), p.502.e1-502.e11
Main Authors: Harris, John A., MD, MSc, Sammarco, Anne G., MD, MPH, Swenson, Carolyn W., MD, Uppal, Shitanshu, MD, Kamdar, Neil, MA, Campbell, Darrel, MD, Evilsizer, Sarah, RN, DeLancey, John O., MD, Morgan, Daniel M., MD
Format: Article
Language:English
Subjects:
Aged
Antibiotic Prophylaxis
bundle
Cohort Studies
Contraindications
Female
Hemostatics
Humans
hysterectomy
Hysterectomy - methods
Laparoscopy
Michigan - epidemiology
morbidity
Obstetrics and Gynecology
Operative Time
Patient Care Bundles
Patient Readmission - statistics & numerical data
Postoperative Complications - epidemiology
Postoperative Complications - prevention & control
Retrospective Studies
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Summary:Background Healthcare teams that frequently follow a bundle of evidence-based processes provide care with lower rates of morbidity. Few process bundles to improve surgical outcomes in hysterectomy have been identified. Objective The purpose of this study was to investigate whether a bundle of 4 perioperative care processes is associated with fewer postoperative complications and readmissions for hysterectomies in the Michigan Surgical Quality Collaborative. Study Design A bundle of perioperative care process goals was developed retrospectively with 30-day peri- and postoperative outcome data from the Hysterectomy Initiative in Michigan Surgical Quality Collaborative. All benign hysterectomies that had been performed between January 2013 and January 2015 were included. Based on evidence of lower complication rates after benign hysterectomy, the following processes were considered to be the “bundle”: use of guideline-appropriate preoperative antibiotics, a minimally invasive surgical approach, operative duration
ISSN:0002-9378
1097-6868
DOI:10.1016/j.ajog.2016.12.173