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Published on: January 17, 2019
The effectiveness of a multidisciplinary, team-based approach to cesarean hysterectomy in modern obstetric practice
Caitlin Gillespie1, Haleh Sangi-Haghpeykar2, Uma Munnur3,4
1School of Allied Health Science, Physician Assistant Program, Baylor College of Medicine, Houston, TX, USA.
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.
