Abstract
Objective:
The aim of this study was to compare the nonsurgical management to surgical intervention for intra-abdominal bleeding after hysterectomy.
Methods:
The study design was a retrospective cohort. International Classification of Disease, ninth revision codes for hemorrhage complicating a procedure (998.11) and acute posthemorrhagic anemia (285.1) were queried for all patients undergoing hysterectomy from September 1996 to September 2006 to identify patients with intra-abdominal bleeding after hysterectomy resulting in nonsurgical management (i.e., transfusion or embolization) or surgical intervention. Outcomes measured were injury to the gastrointestinal tract or urinary tract, life-threatening infection, acute respiratory distress syndrome, abscess, or other life-threatening conditions.
Results:
Of 54 women, 29 were managed nonsurgically and 25 were managed with surgery. The surgical intervention group was less likely to have a major complication (p = 0.002), fever (p = 0.016), infection or abscess (p = 0.024), or readmission (p = 0.012). A source for bleeding was identified in 80% of the surgical group and was more likely to be identified if a reoperation occurred in less than 18 hours (p = 0.039).
Conclusion:
The nonsurgical management of unexpected posthysterectomy bleeding may be associated with higher rates of abscess, fever, and hospital readmission, compared to surgical intervention. A source of bleeding was more likely to be found during the first 18 hours after hysterectomy. (J GYNECOL SURG 25:1)
