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The effectiveness of a multidisciplinary, team‐based approach to cesarean hysterectomy in modern obstetric practice
Author(s) -
Gillespie Caitlin,
SangiHaghpeykar Haleh,
Munnur Uma,
Suresh Maya S.,
Miller Harold,
Hawkins Shan M.
Publication year - 2017
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.12093
Subject(s) - medicine , multidisciplinary approach , hysterectomy , odds ratio , confidence interval , obstetrics , cesarean delivery , quality assurance , retrospective cohort study , multivariate analysis , pregnancy , surgery , social science , external quality assessment , pathology , sociology , biology , genetics
Objective To examine the effectiveness of a multidisciplinary, team‐based approach to management of cesarean hysterectomy. Methods In a retrospective chart review, data were analyzed from a quality assurance database of hysterectomies performed after cesarean delivery at one institution in the USA . Patients were identified through billing codes for cesarean delivery, cross‐referenced to codes for hysterectomy. Demographic, reproductive, and outcome data were compared before (2000–2005) and after (2011–2013) implementation of a multidisciplinary team‐based protocol. Results Across the two study periods, 107 cesarean hysterectomies were identified (69 pre‐implementation, 38 post‐implementation). In univariate analysis, the post‐implementation group had fewer days in surgical intensive care than did the pre‐implementation group (0.21 ± 0.41 vs 1.04 ± 2.44 days; P= 0.011), and a lower frequency of febrile morbidity (4 [11%] vs 22 [32%]; P= 0.033]. In multivariate analysis with adjustment for potential confounders, the likelihood of postoperative febrile morbidity was higher during the pre‐implementation than the post‐implementation period (adjusted odds ratio 3.5, 95% confidence interval 1.09–13.65; P= 0.048). Conclusion Outcomes were improved after the multidisciplinary team‐based approach to cesarean hysterectomy was implemented. Team‐based approaches to care of women undergoing cesarean hysterectomy are important to improve outcomes.