Judd John P, Byrd Kenneth, Jiang Mark
Ochsner J. 2007 Fall;7(3):114-20.
To quantify the readmission rates for total laparoscopic and total abdominal hysterectomy, as well as identify preoperative, intraoperative, and postoperative risk factors for readmission within 6 weeks of surgery.
A retrospective comparative study was performed using a departmental database to identify all readmissions following total laparoscopic and total abdominal hysterectomy and to assemble a control group. For each patient, the following data were systematically collected: surgery date, age, parity, body mass index, indications for surgery, type of procedure performed, uterine size, number of prior cesarean sections, number of prior laparoscopic abdominal surgeries, number of prior open abdominal surgeries, presence of adhesions at time of hysterectomy, diabetic status, operative time, postoperative hematocrit, intraoperative and postoperative complications, surgeon, use of postoperative antibiotics, postoperative day readmitted, reason for readmission, length of readmission, and whether the patient returned to the operating room during the readmission.
From January 1, 2000 to April 1, 2007, 1,576 total abdominal and 1,198 total laparoscopic hysterectomies were performed at Ochsner Medical Center. Of these, 19 abdominal and 31 laparoscopic hysterectomy patients were readmitted within 6 weeks of surgery. Our control groups consisted of 84 laparoscopic and 53 abdominal hysterectomy patients. A statistically significant difference in readmission rates (1.2% following abdominal hysterectomy vs. 2.7% following laparoscopic hysterectomy) was identified. No correlation between readmission and operative time, adhesive disease, diabetic status, prior cesarean sections, prior open or laparoscopic procedures, postoperative antibiotic use or postoperative hematocrit could be identified. Compared to those undergoing abdominal hysterectomy, those undergoing laparoscopic hysterectomy had more readmissions due to cuff dehiscence and cuff cellulitis for (p = 0.0146), which is a previously recognized complication of total laparoscopic hysterectomy. We were unable to identify any significant difference in postoperative day of readmission, length of readmission, or return to operating room.
Further investigation would benefit from an expanded study group, which may result in identification of some significance of the studied factors that were not able to be identified in this study.
量化全腹腔镜子宫切除术和全腹式子宫切除术的再入院率，并确定手术6周内再入院的术前、术中和术后风险因素。
采用科室数据库进行回顾性对比研究，以确定全腹腔镜子宫切除术和全腹式子宫切除术后的所有再入院患者，并组建一个对照组。为每位患者系统收集以下数据：手术日期、年龄、产次、体重指数、手术指征、手术方式、子宫大小、既往剖宫产次数、既往腹腔镜腹部手术次数、既往开腹手术次数、子宫切除时是否存在粘连、糖尿病状态、手术时间、术后血细胞比容、术中和术后并发症、外科医生、术后抗生素使用情况、再入院日期、再入院原因、再入院时长以及患者再入院期间是否返回手术室。
2000年1月1日至2007年4月1日，奥施纳医疗中心共进行了1576例全腹式子宫切除术和1198例全腹腔镜子宫切除术。其中，19例全腹式子宫切除术患者和31例全腹腔镜子宫切除术患者在术后6周内再次入院。我们的对照组由84例腹腔镜子宫切除术患者和53例腹式子宫切除术患者组成。确定了再入院率存在统计学显著差异（腹式子宫切除术后为1.2%，腹腔镜子宫切除术后为2.7%）。未发现再入院与手术时间、粘连性疾病、糖尿病状态、既往剖宫产、既往开腹或腹腔镜手术、术后抗生素使用或术后血细胞比容之间存在相关性。与接受腹式子宫切除术的患者相比，接受腹腔镜子宫切除术的患者因袖口裂开和袖口蜂窝织炎导致的再入院更多（p = 0.0146），这是全腹腔镜子宫切除术先前已公认的并发症。我们未能发现再入院日期、再入院时长或返回手术室方面存在任何显著差异。
扩大研究组将有助于进一步调查，这可能会发现本研究中未能识别的某些研究因素的意义。
