Using over 3000 hysterectomy cases from our network, we created a model to determine factors most predictive of more serious complications at the time of hysterectomy (≥2 complications based on the Clavien Dindo Scale). Grade 1 complications are usually mild but Grade 2 and higher complications are more significant. Examples include (but are not limited to): infections requiring antibiotics, blood transfusions or injury to abdominal or pelvic structures.
Hysterectomy cases used to create this model were completed by General Gynaecologists and those with fellowship training in Minimally Invasive Gynaecologic Surgery. Cases completed by Gynaecologic, Oncologists, or Urogynaecologists were not included. Our outcome of interest, therefore, was a Grade 2 or greater complication based on the Clavien-Dindo Scale. The predicted probability of a Grade 2 or greater complication is generated using a logistic regression model. The final variable inclusions are based on an AIC based step selection procedure along with the consensus of our clinical team based on patient factors known preoperatively. The strongest predictors of serious complication are as follows: previous caesarean section (OR 1.46); open surgical approach (OR 1.80); preoperative anemia (OR 1.54); ASA Class 3 (OR 1.70); ASA Class 4 (OR 3.42); presence of intraoperative endometriosis (OR 1.37); presence of intraoperative adhesions (OR 1.26).
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