Characteristics and outcomes of women undergoing hysterectomy in VA facilities

Weaver FM, Hynes D, Ippolito D, Thakkar B, Cull W, Gibbs J. Characteristics and outcomes of women undergoing hysterectomy in VA facilities. Paper presented at: Addiction Health Services Research Conference; 1999 Jun 1; Chicago, IL.

Objectives: The objectives of this research are to: describe the patient sociodemographic, preoperative risk, structure and process characteristics and outcomes of women undergoing selected procedures at VAMCs; and examine the relationship between sociodemographic, preoperative risk, structure and process characteristics and outcomes for women undergoing select procedures (i.e., hysterectomy, mastectomy, total joint replacement) using multivariate modeling techniques.Methods: This study is a secondary analysis of the National Surgical Quality Improvement Program (NSQIP) database. For the present analyses, all hysterectomy procedures (vaginal, abdominal and laproscopic-assisted) collected by the NSQIP between FY92 and FY97 were selected. The NSQIP contains data on 62 preoperative risk and demographic characteristics, four process, and 23 outcome variables. We supplemented the NSQIP with data from the VA's Patient Treatment File for readmission data, pathology reports from sites, and facility characteristic data. Data from these sources were merged on patient identifiers and procedure date. Any hospitalizations that occurred within one year of the procedure were captured. Outcomes of interest include: post-operative length of stay, morbidity within 30 days (i.e., one or more of 21 complications monitored by the NSQIP), and any readmissions that occurred as a result of a complication of the procedure within one year post surgery. Complications were defined by an expert panel of surgeons who identified relevant diagnostic codes and assigned a time period within which the diagnosis would be considered a complication.Results: Over a six year period, VA performed 1,758 hysterectomies. The majority were for abdominal hysterectomies (75%), whereas 22% were vaginal, and less than 4% were laproscopic-assisted. The most frequent indications for surgery included leioyomas of the uterus (31%), bleeding problems (16%), and endometriosis (10%). Women were predominately white (64%), with an average age of 42.8 years, and a minority were married (37%). Preoperatively, 40% of these women were smokers, 14% had a history of hypertension requiring medications, and 5% were frequent alcohol users. The mean length of stay was 4.2 days (sd = 3.7) and almost 9% experienced one or more of the 21 complications defined by the NSQIP within 30 days of the procedure. Logistic regression modeling of 30-day morbidity identified 6 significant predictors. Preoperative patient variables, including impaired functional status, current smoker, alcohol use within two weeks of admission, dyspnea, and infection, as well as, longer operation times were associated with greater probability of morbidity (c-index = 0.670). Modeling of postoperative length of stay and readmissions due to complications is in process.Conclusions: Research on hysterectomy outcomes have focused on single outcomes and limited examination of preoperative characteristics. This work examining multiple preoperative characteristics and outcomes indicates that risky health behaviors and poorer health status prior to surgery were significant predictors of 30-day mortality.Impact Statements: Women veterans account for less than 5% of all VA health care users. The rate of female-specific procedures at any one facility is very low. Given these infrequent events, this study will help to inform the system as to the types of women who undergo procedures within VA and their outcomes and how this compares to the non-VA health care sector.