Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Perioperative Bundles for Benign Hysterectomy

Am J Obstet Gynecol; ePub 2017 Jan 9; Harris, et al

Reduced morbidity and readmission are associated with rates of perioperative bundle compliance, according to a recent study that investigated if a bundle of 4 perioperative care processes was associated with fewer postoperative complications and readmission in women undergoing benign hysterectomy. The retrospective cohort analysis included 16,286 cases in Michigan with all benign hysterectomies performed between January 2013 and January 2015. Bundle processes included: use of guideline-appropriate preoperative antibiotics, a minimally invasive surgical approach, operative duration <120 minutes, and avoidance of intraoperative hemostatic agent use. Researchers found:

  • 33.6% of the hysterectomies performed met criteria for all bundle processes; although there was a wide variation among the 56 hospitals.
  • Overall, the rate of complication was 6.8% and major complication 2.3%; hospital readmission rate was 3.6%.
  • In cases where all bundle criterion were met, the rate of any complications increased from 4.3% to 7.8%, major complications increased from 1.7% to 2.6%, and readmissions increased from 2.6% to 4.1%.
  • Lower hospital-level rates of postoperative complications and readmissions were observed in facilities meeting all 4 bundle criteria.


Harris JA, Sammarco AG, Swenson CW, et al. Are perioperative bundles associated with reduced postoperative morbidity in women undergoing benign hysterectomy? Retrospective cohort analysis of 16,286 cases in Michigan. [Published online ahead of print January 9, 2017]. Am J Obstet Gynecol. doi:10.1016/j.ajog.2016.12.173.