Postoperative complications after gynecologic surgery

Abstract

Objective: To estimate the association of age, medical comorbidities, functional status, and unintentional weight loss (as a marker of frailty) with postoperative complications in women undergoing major gynecologic surgery.

Methods: We conducted a cross-sectional analysis of the American College of Surgeons National Surgical Quality Improvement Program 2005-2009 participant use data files to analyze gynecologic procedures. The primary outcome was a composite of 30-day major postoperative complications.

Results: A total of 22,214 women were included in our final analysis. The overall prevalence of composite 30-day major postoperative complications was 3.7% (n=817). Age 80 years or older (adjusted odds ratio [OR] 1.8, 95% confidence interval [CI] 1.25-2.58), dependent functional status (adjusted OR 2.37, 95% CI 1.53-3.68), and unintentional weight loss (adjusted OR 2.49, 95% CI 1.48-4.17) were significantly associated with postoperative morbidity after adjusting for diabetes mellitus (adjusted OR 1.44, 95% CI 1.15-1.79), known bleeding disorder (adjusted OR 2.29, 95% CI 1.49-3.52), morbid obesity (adjusted OR 1.77, 95% CI 1.45-2.17), ascites (adjusted OR 3.27, 95% CI 2.18-4.90), preoperative systemic infection (adjusted OR 3.02, 95% CI 2.03-4.48), procedures for gynecologic cancer (adjusted OR 1.60, 95% CI 1.27-2.0), disseminated cancer (adjusted OR 2.57, 95% CI 1.64-4.03), emergency procedures (adjusted OR 1.82, 95% CI 1.18-2.79), operative time more than 4 hours compared with less than 1 hour (adjusted OR 2.91, 95% CI 2.18-3.89), and wound class 4 compared with wound class 1 (adjusted OR 4.28, 95% CI 1.82-10.1).

Conclusion: Age 80 years or older, medical comorbidities, dependent functional status, and unintentional weight loss are associated with increased major postoperative complications after gynecologic procedures.

Level of evidence: III.