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Risk Factors for Febrile Morbidity After Hysterectomy

From Division of Research in Women’s Health & the George Anderson Outcomes Measurement Unit, Department of Obstetrics and Gynecology and Community Health, Brown University Medical School, Women & Infants Hospital, Providence, Rhode Island.

Address reprint requests to: Jeffrey F. Peipert, MD, MPH, Division of Research, Women and Infants Hospital, 101 Dudley Street, Providence, RI 02905; e-mail: jpeipert{at}wihri.org.

OBJECTIVE: To identify risk factors for febrile morbidity after hysterectomy for nonmalignant indications.

METHODS: We performed a retrospective cohort study of 686 women who had a hysterectomy between January and September 1997 by abdominal (n = 408), laparoscopic-assisted vaginal (n = 90), or vaginal (n = 188) approaches. Potential risk factors for febrile morbidity were extracted from the medical records. By means of multivariable logistic regression, we evaluated demographic, reproductive, clinical, and operative risk factors for febrile morbidity.

RESULTS: The risk of postoperative febrile morbidity in this population was 14%. Only 50% of women received prophylactic antibiotics, whereas almost 20% received no antibiotics at all, and 30% were administered antibiotics after surgical incision. Risk factors for febrile morbidity after hysterectomy, after controlling for age, body mass index, operative time, and prophylactic antibiotic administration, were abdominal approach (odds ratio 2.7; 95% confidence interval 1.6, 4.3) and blood loss at surgery of more than 750 mL (odds ratio 3.5; 95% confidence interval 1.8, 6.8).

CONCLUSION: Hysterectomy by abdominal approach and increased blood loss at the time of surgery significantly increase the risk of febrile morbidity. Preventive efforts should focus on methods to reduce postoperative febrile morbidity, including meticulous surgical technique and routine use and appropriate timing of prophylactic antibiotic therapy.

LEVEL OF EVIDENCE: II-2

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