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postgraduate thesis: Clinical characterization of patients undergoing hysterectomy with and without postoperative pyrexia

TitleClinical characterization of patients undergoing hysterectomy with and without postoperative pyrexia
Authors
Issue Date2015
PublisherThe University of Hong Kong (Pokfulam, Hong Kong)
Citation
Deng, L. [邓粮]. (2015). Clinical characterization of patients undergoing hysterectomy with and without postoperative pyrexia. (Thesis). University of Hong Kong, Pokfulam, Hong Kong SAR. Retrieved from http://dx.doi.org/10.5353/th_b5662563
AbstractBackground Hysterectomy is one of the most frequently performed procedure throughout the world in women. Postoperative pyrexia and infections are the major complications following hysterectomy. Incidence of post-hysterectomy fever varies from 14% to 76%. Postoperative pyrexia was considered a hallmark of underlying infection and is related to the extended length of stay and increasing hospital costs. Although it has been reported that different onset time of fever are usually associated with either infectious or non-infectious causes, there is no systematic survey on the profiling of postoperative pyrexia following this major gynecologic surgery. Factors that may contribute to, or associate with this were not clear. This study used data collected from the retrospective clinical cases to describe the profiles of postoperative febrile patients who underwent hysterectomy, to reveal risk factors involved in the fever development and to define the indicator for post-hysterectomy infections. Methods We performed a retrospective cohort study of 526 patients who had hysterectomy for a benign condition between June 2012 and June 2014 at a Class A secondary comprehensive hospital in Panyu, Guangdong, China. Descriptive statistics were conducted to describe the demographic and clinical characteristics of these patients. Chi-square test, two-independent sample t-test, Mann-Whitney U test and nonparametric median test were used to compare differences in surgical approaches, febrile status and presence of infections. Logistic regression was conducted to assess the risk factors correlated with postoperative fever and infections.. Receiver operating characteristic curves were formed to compare sensitivity and specificity of related fever definition. Results Among the 526 women patients with benign conditions, laparoscopic approach was the foremost option for hysterectomy, accounting for 62.5% of the surgeries conducted. Only 27 (5.1%) of these patients underwent vaginal hysterectomy. All patients were given prophylactic antibiotics after the surgery. A total of 222 (42.2%) women experienced postoperative fever (≥38°C) and only 41 (8.2%) developed confirmed infections. Multivariate analysis showed that surgical approach, and type and timing of prophylactic antibiotics were associated with postoperative fever . Fever definition 6 (T 39.1°C or more within first 48 h, or T 38.0°C or more after 72 h) could served as a single indicator of infections, which had a sensitivity of 75.6% and a specificity of 88.9%. The area under the curve (AUC) was 0.822 (95% CI, 0.774- 0.901) while the positive predictive value was 36.5%. However, no other clinical parameter was statistically significant associated with postoperative infections and surgical-associated infections following hysterectomy. Conclusions Abdominal approach, and timing and type of antibiotics given to the patients were associated with higher cumulative incidence of post-hysterectomy fever. Preventive efforts should be made to encourage vaginal and laparoscopic approach and regular use of antibiotics after surgery. Further evaluation for the current prophylactic antibiotic protocols used for patients who had hysterectomy is needed. Risk factors related to different kinds of infections should also be explored to reduce the excessive medical treatment and unnecessary cost for the patients undergoing empiric prophylaxis and therapy with prolonged usage of antibiotics.
DegreeMaster of Public Health
SubjectHysterectomy
Fever
Dept/ProgramPublic Health
Persistent Identifierhttp://hdl.handle.net/10722/221753

 

DC FieldValueLanguage
dc.contributor.authorDeng, Liang-
dc.contributor.author邓粮-
dc.date.accessioned2015-12-09T00:20:49Z-
dc.date.available2015-12-09T00:20:49Z-
dc.date.issued2015-
dc.identifier.citationDeng, L. [邓粮]. (2015). Clinical characterization of patients undergoing hysterectomy with and without postoperative pyrexia. (Thesis). University of Hong Kong, Pokfulam, Hong Kong SAR. Retrieved from http://dx.doi.org/10.5353/th_b5662563-
dc.identifier.urihttp://hdl.handle.net/10722/221753-
dc.description.abstractBackground Hysterectomy is one of the most frequently performed procedure throughout the world in women. Postoperative pyrexia and infections are the major complications following hysterectomy. Incidence of post-hysterectomy fever varies from 14% to 76%. Postoperative pyrexia was considered a hallmark of underlying infection and is related to the extended length of stay and increasing hospital costs. Although it has been reported that different onset time of fever are usually associated with either infectious or non-infectious causes, there is no systematic survey on the profiling of postoperative pyrexia following this major gynecologic surgery. Factors that may contribute to, or associate with this were not clear. This study used data collected from the retrospective clinical cases to describe the profiles of postoperative febrile patients who underwent hysterectomy, to reveal risk factors involved in the fever development and to define the indicator for post-hysterectomy infections. Methods We performed a retrospective cohort study of 526 patients who had hysterectomy for a benign condition between June 2012 and June 2014 at a Class A secondary comprehensive hospital in Panyu, Guangdong, China. Descriptive statistics were conducted to describe the demographic and clinical characteristics of these patients. Chi-square test, two-independent sample t-test, Mann-Whitney U test and nonparametric median test were used to compare differences in surgical approaches, febrile status and presence of infections. Logistic regression was conducted to assess the risk factors correlated with postoperative fever and infections.. Receiver operating characteristic curves were formed to compare sensitivity and specificity of related fever definition. Results Among the 526 women patients with benign conditions, laparoscopic approach was the foremost option for hysterectomy, accounting for 62.5% of the surgeries conducted. Only 27 (5.1%) of these patients underwent vaginal hysterectomy. All patients were given prophylactic antibiotics after the surgery. A total of 222 (42.2%) women experienced postoperative fever (≥38°C) and only 41 (8.2%) developed confirmed infections. Multivariate analysis showed that surgical approach, and type and timing of prophylactic antibiotics were associated with postoperative fever . Fever definition 6 (T 39.1°C or more within first 48 h, or T 38.0°C or more after 72 h) could served as a single indicator of infections, which had a sensitivity of 75.6% and a specificity of 88.9%. The area under the curve (AUC) was 0.822 (95% CI, 0.774- 0.901) while the positive predictive value was 36.5%. However, no other clinical parameter was statistically significant associated with postoperative infections and surgical-associated infections following hysterectomy. Conclusions Abdominal approach, and timing and type of antibiotics given to the patients were associated with higher cumulative incidence of post-hysterectomy fever. Preventive efforts should be made to encourage vaginal and laparoscopic approach and regular use of antibiotics after surgery. Further evaluation for the current prophylactic antibiotic protocols used for patients who had hysterectomy is needed. Risk factors related to different kinds of infections should also be explored to reduce the excessive medical treatment and unnecessary cost for the patients undergoing empiric prophylaxis and therapy with prolonged usage of antibiotics.-
dc.languageeng-
dc.publisherThe University of Hong Kong (Pokfulam, Hong Kong)-
dc.relation.ispartofHKU Theses Online (HKUTO)-
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.rightsThe author retains all proprietary rights, (such as patent rights) and the right to use in future works.-
dc.subject.lcshHysterectomy-
dc.subject.lcshFever-
dc.titleClinical characterization of patients undergoing hysterectomy with and without postoperative pyrexia-
dc.typePG_Thesis-
dc.identifier.hkulb5662563-
dc.description.thesisnameMaster of Public Health-
dc.description.thesislevelMaster-
dc.description.thesisdisciplinePublic Health-
dc.description.naturepublished_or_final_version-

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