Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, Columbia University, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, Columbia University, New York, NY.
Am J Obstet Gynecol. 2013 Nov;209(5):420.e1-8. doi: 10.1016/j.ajog.2013.08.006. Epub 2013 Aug 9.
There is growing recognition that, in addition to occurrence of perioperative complications, the treatment of patients with complications influences outcome. We examined complications, failure to rescue (death in patients with a complication), and mortality rates for women who underwent abdominal hysterectomy.
Women who underwent abdominal hysterectomy from 1998-2010 and whose data were recorded in the Nationwide Inpatient Sample were identified. Hospitals were stratified based on risk-adjusted mortality rates into 5 quintiles, and rates of complications and failure to rescue were examined.
A total of 664,229 women who had been treated at 741 hospitals were identified. The overall mortality rate for the cohort was 0.17%. The risk-adjusted, hospital-level mortality rate ranged from 0-1.12%. The complication rate was 6.5% at the hospitals with the lowest mortality rates, 9.9% at the second quintile hospitals, 9.5% at both the third and fourth quintile hospitals, and 7.9% at the hospitals with the highest mortality rates. In contrast to complications, the failure-to-rescue rate increased with each successive risk-adjusted mortality quintile. The failure-to-rescue rate was 0% at the hospitals with the lowest mortality rates and increased with each successive quintile to 1.1%, 2.1%, 2.7%, and 4.4% in the hospitals with the highest mortality rates (P < .0001).
For women who underwent abdominal hysterectomy, hospital complication rates correlated poorly with mortality rates; failure-to-rescue is strongly associated with in-hospital mortality rates. The treatment of complications, not the actual development of a complication, is the most important factor to use to predict death after major gynecologic surgery.
人们越来越认识到，除了围手术期并发症的发生外，并发症的治疗也会影响结局。我们研究了行腹式子宫切除术患者的并发症、治疗失败（发生并发症患者的死亡）和死亡率。
我们确定了 1998 年至 2010 年行腹式子宫切除术且数据记录在全国住院患者样本中的女性。根据风险调整死亡率将医院分层为 5 个五分位组，并检查并发症和治疗失败的发生率。
我们共确定了 741 家医院的 664229 名接受治疗的女性。该队列的总体死亡率为 0.17%。风险调整后的医院级别死亡率范围为 0-1.12%。并发症发生率在死亡率最低的医院为 6.5%，第二五分位组的医院为 9.9%，第三和第四五分位组的医院为 9.5%，死亡率最高的医院为 7.9%。与并发症不同，治疗失败的发生率随着风险调整死亡率五分位组的增加而增加。死亡率最低的医院治疗失败的发生率为 0%，随着五分位组的递增，死亡率分别为 1.1%、2.1%、2.7%和 4.4%，在死亡率最高的医院（P<.0001）。
对于行腹式子宫切除术的女性，医院并发症发生率与死亡率相关性差；治疗失败与院内死亡率密切相关。治疗并发症而不是发生并发症本身，是预测妇科大手术后死亡的最重要因素。
