A retrospective cohort study of hemostatic agent use during hysterectomy and risk of post-operative complications.
OBJECTIVE
To determine if the use of intraoperative hemostatic agents was a risk factor for post-operative adverse events within 30 days of patients undergoing hysterectomy.


METHOD
A population-based retrospective cohort study included data from patients undergoing hysterectomy for any indication between January 1, 2013, and December 31, 2014, at 52 hospitals in Michigan, USA. Any individuals with missing covariate data were excluded, and multivariable logistic regression and propensity score-matching were used to estimate the rate of post-operative adverse events associated with intra-operative hemostatic agents independent of demographic and surgical factors.


RESULTS
There were 17 960 surgical procedures included in the analysis, with 4659 (25.9%) that included the use of hemostatic agents. Hemostatic agent use was associated with an increase in predicted hospital re-admissions (P=0.007). Among all hysterectomy approaches, and after adjusting for demographic and surgical factors, hemostatic agent use during robotic-assisted laparoscopic hysterectomy was associated with an increased predicted rate of blood transfusions (P=0.019), an increased predicted rate of pelvic abscess diagnoses (P=0.001), an increased predicted rate of hospital re-admission (P=0.001), and an increased predicted rate of re-operation (P=0.021).


CONCLUSION
Hemostatic agents should be used carefully owing to associations with increased post-operative re-admissions and re-operations when used during hysterectomy.
['Harris|John A|JA|', 'Uppal|Shitanshu|S|', 'Kamdar|Neil|N|', 'Swenson|Carolyn W|CW|', 'Campbell|Darrell|D|', 'Morgan|Daniel M|DM|']
D000328:Adult D001803:Blood Transfusion D005260:Female D006490:Hemostatics D006801:Humans D007044:Hysterectomy D010535:Laparoscopy D016015:Logistic Models D008824:Michigan D008875:Middle Aged D015999:Multivariate Analysis D010343:Patient Admission D034161:Pelvic Infection D011183:Postoperative Complications D012086:Reoperation D012189:Retrospective Studies D012307:Risk Factors
Hemostatic agents Hysterectomy Complications Blood transfusions Pelvic abscess Hospital readmissions Propensity score matching