Predictors of complications in gynaecological oncological surgery: a prospective multicentre study (UKGOSOC-UK gynaecological oncology surgical outcomes and complications)

R Iyer, A Gentry-Maharaj, A Nordin, M Burnell, R Liston, R Manchanda, N Das, R Desai, R Gornall, A Beardmore-Gray, J Nevin, K Hillaby, S Leeson, A Linder, A Lopes, D Meechan, T Mould, S Varkey, A Olaitan, B Rufford, A Ryan, S Shanbhag, A Thackeray, N Wood, K Reynolds, U Menon, R Iyer, A Gentry-Maharaj, A Nordin, M Burnell, R Liston, R Manchanda, N Das, R Desai, R Gornall, A Beardmore-Gray, J Nevin, K Hillaby, S Leeson, A Linder, A Lopes, D Meechan, T Mould, S Varkey, A Olaitan, B Rufford, A Ryan, S Shanbhag, A Thackeray, N Wood, K Reynolds, U Menon

Abstract

Background: There are limited data on surgical outcomes in gynaecological oncology. We report on predictors of complications in a multicentre prospective study.

Methods: Data on surgical procedures and resulting complications were contemporaneously recorded on consented patients in 10 participating UK gynaecological cancer centres. Patients were sent follow-up letters to capture any further complications. Post-operative (Post-op) complications were graded (I-V) in increasing severity using the Clavien-Dindo system. Grade I complications were excluded from the analysis. Univariable and multivariable regression was used to identify predictors of complications using all surgery for intra-operative (Intra-op) and only those with both hospital and patient-reported data for Post-op complications.

Results: Prospective data were available on 2948 major operations undertaken between April 2010 and February 2012. Median age was 62 years, with 35% obese and 20.4% ASA grade ⩾3. Consultant gynaecological oncologists performed 74.3% of operations. Intra-op complications were reported in 139 of 2948 and Grade II-V Post-op complications in 379 of 1462 surgeries. The predictors of risk were different for Intra-op and Post-op complications. For Intra-op complications, previous abdominal surgery, metabolic/endocrine disorders (excluding diabetes), surgical complexity and final diagnosis were significant in univariable and multivariable regression (P<0.05), with diabetes only in multivariable regression (P=0.006). For Post-op complications, age, comorbidity status, diabetes, surgical approach, duration of surgery, and final diagnosis were significant in both univariable and multivariable regression (P<0.05).

Conclusions: This multicentre prospective audit benchmarks the considerable morbidity associated with gynaecological oncology surgery. There are significant patient and surgical factors that influence this risk.

References

    1. .
    1. .
    1. Aletti G, Dowdy S, Podratz K, Cliby W. Relationship among surgical complexity, short-term morbidity, and overall survival in primary surgery for advanced ovarian cancer. Am J Obst Gynecol. 2007a;197 (6:676.e1–e7.
    1. Aletti GD, Santillan A, Eisenhauer EL, Hu J, Aletti G, Podratz KC, Bristow RE, Chi DS, Cliby WA. A new frontier for quality of care in gynecologic oncology surgery: multi-institutional assessment of short-term outcomes for ovarian cancer using a risk-adjusted model. Gynecol Oncol. 2007b;107 (1:99–106.
    1. Bridgewater B. Cardiac registers: the adult cardiac surgery register. Heart. 2010;96 (18:1441–1443.
    1. Brummer THI, Jalkanen J, Fraser J, Heikkinen A-M, Kauko M, Mäkinen J, Seppälä T, Sjöberg J, Tomás E, Härkki P. FINHYST, a prospective study of 5279 hysterectomies: complications and their risk factors. Hum Reprod. 2011;26:1741–1751.
    1. Cockbain AJ, Carolan M, Berridge D, Toogood GJ. Performance and quality indicators: the importance of accurate coding. Bull Royal Coll Surg Engl. 2012;94 (2:46–50.
    1. Copeland G. The POSSUM system of surgical audit. Arch Surg. 2002;137 (1:15–19.
    1. Das N, Talaat AS, Naik R, Lopes AD, Godfrey KA, Hatem MH, Edmondson RJ. Risk adjusted surgical audit in gynaecological oncology: P-POSSUM does not predict outcome. Eur J Surg Oncol. 2006;32 (10:1135.
    1. Dindo D, Demartines N, Clavien PA. Classification of surgical complications - a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240 (2:205–213.
    1. Fischer JP, Tuggle CT, Au A, Kovach SJ. A 30-day risk assessment of mastectomy alone compared to immediate breast reconstruction (IBR) J Plast Surg Hand Surg. 2014;0 (0:1–7.
    1. Gimenes C, Barrile S, Martinelli B, Ronchi C, Arca E, Gimenes R, Okoshi M, Okoshi K. Association of pre and intraoperative variables with postoperative complications in coronary artery bypass graft surgery. Rev Bras Cir Cardiovasc. 2013;28 (4:518.
    1. Hacker NF. Quality control in ovarian cancer surgery. Ann Oncol. 2011;22 (Suppl 8:viii19.
    1. Iyer R, Gentry Maharaj A, Nordin A, Liston R, Burnell M, Das N, Desai R, Gornall R, Beardmore Gray A, Hillaby K, Leeson S, Linder A, Lopes A, Meechan D, Mould T, Nevin J, Olaitan A, Rufford B, Ryan A, Shanbhag S, Thackeray A, Wood N, Reynolds K, Menon U. Patient-reporting improves estimates of postoperative complication rates: a prospective cohort study in gynaecological oncology. Br J Cancer. 2013;109 (3:623.
    1. Khuri SF. The Department of Veterans Affairs' NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. Ann Surg. 1998;228 (4:491–507.
    1. Kondalsamy Chennakesavan S, Bouman C, De Jong S, Sanday K, Nicklin J, Land R, Obermair A. Clinical audit in gynecological cancer surgery: development of a risk scoring system to predict adverse events. Gynecol Oncol. 2009;115 (3:329.
    1. Liang D, Zhimin H, Haijun X, Leizi C, Feng X. Risk factors for postoperative wound complications of calcaneal fractures following plate fixation. Foot Ankle Int. 2013;34 (9:1238–1244.
    1. Mota F, Vergote I, Trimbos JB, Amant F, Siddiqui N, Del Rio A, Verheijen R, Zola P. Classification of radical hysterectomy adopted by the Gynecological Cancer Group of the European Organization for Research and Treatment of Cancer. Int J Gynecol Cancer. 2008;18 (5:1136–1138.
    1. National Bowel Cancer Audit Programme: Healthcare Quality Improvement Partnership (HQIP) Reports of the National Bowel Cancer Audit Project 2002–2006 .
    1. Park J-Y, Kim D-Y, Kim J-H, Kim Y-M, Kim Y-T, Nam J-H. Laparoscopic versus open radical hysterectomy in patients with stage IB2 and IIA2 cervical cancer. J Surg Oncol. 2013;108 (1:63–69.
    1. Peersman G, Laskin R, Davis J, Peterson MGE, Richart T. Prolonged operative time correlates with increased infection rate after total knee arthroplasty. HSS J. 2006;2 (1:70–72.
    1. Pull T, Hosman AJ, Cohen DB, Schuetz M, Habil D, van L, van M. A methodological systematic review on surgical site infections following spinal surgery: part 1: risk factors. Spine (Phila, Pa 1976) 2012;37 (24:2017–2033.
    1. RCOG 2012. Hospital Episode Statistics as a source of information on safety and quality in gynaecology to support revalidation.
    1. Sokol D, Wilson J. What is a surgical complication. World J Surg. 2008;32 (6:942–944.
    1. Soliani P. New classification of physical status. Anesthesiology. 1963;24:111.
    1. Van Der Krabben AA, Dijkstra FR, Nieuwenhuijzen M, Reijnen MM, Schaapveld M, Van Goor H. Morbidity and mortality of inadvertent enterotomy during adhesiotomy. Br J Surg. 2000;87 (4:467–471.
    1. van der Pas MHGM, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WCJ, Bonjer HJ. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14 (3:210–218.
    1. Walker J, Piedmonte M, Spirtos N, Eisenkop S, Schlaerth J, Mannel R, Spiegel G, Barakat R, Pearl M, Sharma S. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. J Clin Oncol. 2009;27 (32:5331.
    1. Westaby S, Archer N, Manning N, Adwani S, Grebenik C, Ormerod O, Pillai R, Wilson N. Comparison of hospital episode statistics and central cardiac audit database in public reporting of congenital heart surgery mortality. BMJ. 2007;335 (7623:759.
    1. WHO 1990. International Statistical Classification of Diseases and Related Health Problems 10th Revision.
    1. Wills A, Obermair A. A review of complications associated with the surgical treatment of vulvar cancer. Gynecol Oncol. 2013;131 (2:467.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться