The effectiveness of a multidisciplinary, team-based approach to cesarean hysterectomy in modern obstetric practice

Caitlin Gillespie, Haleh Sangi-Haghpeykar, Uma Munnur, Maya S. Suresh, Harold Miller, Shannon Hawkins

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)57-62
Number of pages6
JournalInternational Journal of Gynecology and Obstetrics
Volume137
Issue number1
DOIs
StatePublished - Apr 1 2017
Externally publishedYes

Keywords

  • Cesarean delivery
  • Clinical outcomes
  • Hysterectomy
  • Morbidly adherent placenta
  • Obstetric emergency
  • Postpartum hemorrhage
  • Quality improvement

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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