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Major Postoperative Complications After Benign Gynecologic Surgery: A Clinical Prediction Tool

Erekson, Elisabeth A. MD, MPH; Yip, Sallis O. MD; Martin, Deanna K. MPH; Ciarleglio, Maria M. PhD; Connell, Kathleen A. MD; Fried, Terri R. MD

Female Pelvic Medicine & Reconstructive Surgery: September/October 2012 - Volume 18 - Issue 5 - p 274–280
doi: 10.1097/SPV.0b013e318263a210
Original Articles

Objective The objective of this study was to create a clinical prediction tool to differentiate women at risk for postoperative complications after benign gynecologic surgery.

Methods We utilized the 2005 to 2009 American College of Surgeons National Surgical Quality Improvement Program participant use data files to perform a secondary data-set analysis of women older than 16 years who underwent benign gynecologic procedures. We then temporally divided women into 2 similar cohorts. Our derivation cohort included all women undergoing benign gynecologic procedures in 2005 to 2008. Our validation cohort included all women undergoing benign gynecologic procedures in 2009. The primary outcome, composite 30-day major postoperative complications, was analyzed as a dichotomous variable. A prediction tool was then constructed to predict the occurrence of postoperative complications built from the logistic regression model by rounding the value of each estimated β coefficient to the nearest integer. An individual’s risk score was then computed by summing the number of points based on her preoperative characteristics. This risk score was then used to categorize women into low-, medium-, and high-risk groups.

Results A prediction tool for benign gynecologic procedures identified women at low (2.7% and 2.4%), medium (6.3% and 6.8%), and high (29.5% and 23.8%) risk of complications in the derivation and validation cohorts, respectively.

Conclusions A prediction tool can differentiate women at risk for postoperative complications after benign gynecologic surgery.

A preoperative prediction tool was developed to identify women at risk for postoperative complications after benign gynecologic procedures.

From the *Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, and †Yale Center for Analytical Sciences, Yale University School of Public Health, New Haven, CT; ‡Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver, CO; and §Section of Geriatrics, Yale University School of Medicine, New Haven, CT.

Reprints: Elisabeth A. Erekson, MD, MPH, Yale University, Section of Urogynecology, 333 Cedar St, PO Box 208063, New Haven, CT 06519. E-mail: elisabeth.erekson@yale.edu.

Dr Terri Fried is supported by K24 AG28443, National Institute on Aging. No funding was provided for this research or development of the manuscript.

The authors declare that they have nothing to disclose.

The American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS NSQIP are the sources of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.