Approximately 7 percent of women e...

Approximately 7 percent of women exhibit significant fever following elective vaginal hysterectomy for benign conditions compared with about 17 percent of those who bear abdominal hysterectomy. Meta-analysis has attributed a great deal of of this difference to more of frequent occurrence use of prophylactic antibiotics in vaginal processs The latter led to the widespread use of prophylactic antibiotics for hysterectomy because patients at increased risk could not be easily identified among all patients undergoing the conduct Peipert and colleagues conducted a retrospective cohort consideration of nearly 700 women undergoing hysterectomy at a university medical center to better understand risk factors for heat following surgery. They aimed to use the data from this cogitation to develop clinical algorithms to improve the quality of care for women undergoing hysterectomy.

They studied data in succession all women undergoing hysterectomy for benign conditions during a nine-month period. The research assistants abstracting the demographic and clinical data were not aware of the research hypothesis.

During the consideration 408 (60 percent) women underwent abdominal hysterectomy, 90 (13 percent) had laparoscopic-assisted vaginal hysterectomy, and 188 (27 percent) had vaginal hysterectomies. The women ranged in age from 25 to 83 years, about 65 percent were white, and more than 80 percent had private insurance or were members of a health maintenance organization. Women who had abdominal measures tended to be younger, have higher visible form [i]or[/i] frame mass indexes, be nulliparous, and have private health insurance. Otherwise, the women did not differ significantly on surgical approach. The lowest line loss was associated with vaginal hysterectomy. Operating times were similar for abdominal and vaginal hysterectomies, further laparoscopic-assisted vaginal hysterectomy had the longest surgical times. More than individual half of women undergoing the latter conduct had operating times longer than couple hours.

Overall, 96 (14 percent) women evolveed significant postoperative fever. The risk was significantly higher in abdominal cases (18 percent) than with laparoscopic-assisted vaginal approaches (9 percent) or vaginal surgeries (8 percent) Overall, common half of the women received prophylactic antibiotics. Forty-five percent of women with abdominal approaches, 53 percent of those with laparoscopic-assisted vaginal actions and 59 percent of those with vaginal hysterectomies received antibiotics. Cefazolin was the mostly common agent used. In statistical analysis, barely surgical approach and estimated life-blood loss predicted febrile morbidity. After controlling for age, material substance mass index, operative time, and prophylactic antibiotic use, the remainings ratio was 2.5 for febrile morbidity with the abdominal approach and 37 for an operative descendants loss of 750 mL or more.

The authors finish that the risk of postoperative excitement is doubled in abdominal hysterectomy and significantly increased with excessive vital current loss. These results correlate with data from other studies. The exces risk in abdominal surgeries may be attributable in part to the les usual use of prophylactic antibiotics. Inconsistencies in the timing of antibiotic administration also could contribute to suboptimal pre-vention of postoperative excitement They suggest that febrile morbidity could be reduc by dint of more frequent use of vaginal surgi-cal approaches, at taking precautions for reducing house loss during surgery, and by means of greater use of appropriately timed prophy-lactic antibiotics.

Peipert JF et al. Risk factors for febrile morbidity after hysterectomy. Obstet Gynecol January 2004;103:86-91

COPYRIGHT 2004 American Academy of Family Physicians

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