Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio, United States.
Department of Obstetrics and Gynecology, MetroHealth Medical Center, Cleveland, Ohio, United States; Division of Female Pelvic Medicine and Reconstructive Surgery, MetroHealth Medical Center, Cleveland, Ohio, United States; Case Western Reserve University School of Medicine, Cleveland, Ohio, United States.
Eur J Obstet Gynecol Reprod Biol. 2020 May;248:144-149. doi: 10.1016/j.ejogrb.2020.03.041. Epub 2020 Mar 19.
To evaluate whether preoperative laboratory tests are predictive of surgical complications in the first 30 days after benign hysterectomy.
Data was collected from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) of patients undergoing benign hysterectomy between 2014 and 2016. Patients with significant medical comorbidities were excluded except for current smoking and hypertension. Patients were stratified into those who did and did not undergo preoperative testing. Laboratory results were stratified into normal and abnormal values. The primary outcome was the composite complication rate between groups. Student'st-test, Fisher's exact test, and Wilcoxon Rank-Sum were used for statistical analysis where appropriate. Multivariable regression analysis was used to determine which variables were independently predictive of postoperative complications.
A total of 24,752 patients met all inclusion criteria. Of these, 92.5% had at least one preoperative test performed, and out of those 33.5% had an abnormal value. The most common test performed was a complete blood count, 92.5%, and the least common were coagulation studies, 16.1%. Patients who underwent testing were younger (45.9 vs 47.8 years, p < 0.001), more likely to smoke (15.3% vs 12.7%, p = 0.004) and less likely to have hypertension (18.9% vs 21.8%, p = 0.001). The most common abnormality was a low hematocrit, and the least common anomaly was an elevated international normalized ratio. The total complication rate was 9.2%, and there were no differences between groups (p = 0.07). The only lab value associated with an increased risk of complications was a hematocrit less than 34.9% (aOR 2.74, 95%CI 2.92-3.79) and WBC count >11 thousand per microliter (aOR 2.11, 95%CI 1.53-3.09).
Non-hematologic preoperative laboratory anomalies are uncommon in healthy women undergoing benign hysterectomy by any modality and furthermore non-hematologic abnormalities are not predictive of post-operative complications. On the other hand, hematologic abnormalities are fairly common and a WBC above 11 cells per uL and hematocrit below 34.9% are predictive of postoperative complications.
评估良性子宫切除术后 30 天内术前实验室检查是否对手术并发症有预测作用。
数据来自美国外科医师学院国家外科质量改进计划（NSQIP）2014 年至 2016 年间接受良性子宫切除术的患者。除了当前吸烟和高血压外，排除有重大合并症的患者。患者分为进行术前检查和未进行术前检查的患者。实验室结果分为正常和异常值。主要结果是组间复合并发症发生率。适当情况下使用 Student's t 检验、Fisher 确切检验和 Wilcoxon 秩和检验进行统计学分析。多变量回归分析用于确定哪些变量是术后并发症的独立预测因素。
共有 24752 名患者符合所有纳入标准。其中，92.5%的患者至少进行了一次术前检查，其中 33.5%的患者检查结果异常。最常见的检查是全血细胞计数，占 92.5%，最少见的是凝血研究，占 16.1%。接受检查的患者更年轻（45.9 岁 vs 47.8 岁，p < 0.001），更有可能吸烟（15.3% vs 12.7%，p = 0.004），高血压的可能性更小（18.9% vs 21.8%，p = 0.001）。最常见的异常是低血细胞比容，最常见的异常是国际标准化比值升高。总并发症发生率为 9.2%，两组之间无差异（p = 0.07）。唯一与并发症风险增加相关的实验室值是血细胞比容低于 34.9%（比值比 2.74，95%CI 2.92-3.79）和白细胞计数>11000 个/微升（比值比 2.11，95%CI 1.53-3.09）。
无论采用何种方式，行良性子宫切除术的健康女性中，非血液学术前实验室异常均不常见，此外，非血液学异常不能预测术后并发症。另一方面，血液学异常较为常见，白细胞计数超过 11 个/微升和血细胞比容低于 34.9%可预测术后并发症。
