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

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.

The NICE classification for ‘Ultra‐radical (extensive) surgery for advanced ovarian cancer’ guidance does not meaningfully predict postoperative complications: a cohort study

“…It is hardly surprising that patients treated with ‘ultra‐radical’ surgery experience higher rates of major complications than patients managed with standard surgery . Although surgical complexity has long been associated with postoperative morbidity, our study is the first to demonstrate that standard and ‘ultra‐radical’ surgery of similar surgical complexities have similar major complication rates, suggesting that the actual number of procedures performed is a more important driver of postoperative morbidity than the procedure types themselves.…”

Surgical Apgar score in prediction of post-operative complications in gynecological surgery

“…Iyer and colleagues and Zighelboim and colleagues found age to be a significant predictor of postoperative complications but it is relevant to point out here that they had included only gynecological oncology surgery patients while this study included all women undergoing laparotomy. 6,7 BMI was also not found to be associated with postoperative complications. Previous studies had found that unintentional weight loss, which is a marker of frailty, and morbid obesity (BMI ≥40 kg/m 2 ) are associated with increased major postoperative complications.…”

“…This is consistent with the findings of aforementioned studies. 4,6,7 Zighelboim et al recorded comorbidities in the same way as was done in the study (described in ‗Materials and methods') and found multiple comorbidities to be significantly associated (p = <0.00001) with significant postoperative complications. 7 As seen from the results, SAS was found to be significantly associated with postoperative complications.…”

Benchmarking of surgical complications in gynaecological oncology: prospective multicentre study

“…Surgical data on a national level has been collected in specialties such as cardiothoracic and orthopaedic surgery and certain cancers such as lung, colorectal and head and neck; there is a paucity of such data in gynaecological oncology (GO). To address this, the United Kingdom Gynaecological Oncology Surgical Outcomes and Complications (UKGOSOC) study was undertaken to prospectively capture data on surgery with a view to setting benchmarking standards. In this cohort, the overall intraoperative (IntraOp) complication rate (CR) was 4.7% and the postoperative (PostOp) CR was 25.7% .…”

“…To address this, the United Kingdom Gynaecological Oncology Surgical Outcomes and Complications (UKGOSOC) study was undertaken to prospectively capture data on surgery with a view to setting benchmarking standards. In this cohort, the overall intraoperative (IntraOp) complication rate (CR) was 4.7% and the postoperative (PostOp) CR was 25.7% . However, use of observed CRs for centre‐level comparisons does not take into account patient co‐morbidity, underlying disease or surgical complexity, all of which can impact on the risk of a complication .…”