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The morbidity of abdominal hysterectomy.

OBJECTIVE
To determine the morbidity of abdominal hysterectomy.


DESIGN
Descriptive. Physician billings to the Quebec Health Care Plan in the 1-month period after abdominal hysterectomy were examined.


SETTING
Operations performed in 102 hospitals in the Province of Quebec between Jan. 1, 1989, and Mar. 31, 1989, were selected.


PATIENTS
The study group included 3322 patients who had abdominal hysterectomy. Patients who had vaginal or abdominal hysterectomy for invasive cancer or pregnancy-related complications were excluded. A patient was considered to be morbid if the physician's intervention indicated concern for the patient's well-being.


MAIN OUTCOME MEASURES
Multiple logistic regression analysis to determine the adjusted rate ratio for inclusion in a categorical list of morbid patients among different subsets of surgeons, hospitals and patients.


RESULTS
Postoperative morbidity occurred in 646 patients (19.5%), who spent an average of 1.7 days longer in the hospital than patients with no postoperative morbidity. There were two postoperative deaths (0.1%). Forty-nine patients (1.5%) had postoperative surgical intervention. On 119 occasions (3.6%), patients were treated in the intensive care unit. A consultation was given by a medical specialist in 303 cases (9.1%). The rate ratio for postoperative morbidity was not significantly affected by years in practice or specialty of the surgeon but was increased for operations performed in mid-sized hospitals. The strongest predictor of postoperative morbidity was pre-existing medical disorder (RR).


CONCLUSION
The major causes of morbidity in patients who undergo abdominal hysterectomies are medical rather than surgical.