Characterization of pre-operative anemia in patients undergoing surgery by a gynecologic oncologist and association with post-operative complications

Foley, Olivia W.; Vega, Brenda; Roque, Dario R.; Hinchcliff, Emily; Marcus, Jenna; Tanner, Edward J.; Barber, Emma L.

doi:10.1136/ijgc-2023-004539

Cited by 4 publications

References 34 publications

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The impact of perioperative transfusions on the oncologic outcomes of patients with ovarian cancer: A population‐based study

Bouchard‐Fortier,

Gien,

Chan

et al. 2024

Journal of Surgical Oncology

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Perioperative blood transfusion in ovarian cancer patients was associated with a 28% increase in all‐cause mortality. The negative impact of perioperative blood transfusion extends beyond the immediate postoperative period.ObjectivesThe effect of perioperative blood transfusions on long‐term oncologic outcomes of patients with advanced ovarian cancer undergoing cytoreductive surgery remains uncertain. Our study aims to determine the association between perioperative blood transfusion and all‐cause mortality in this population.MethodsUsing province‐wide administrative databases, patients with advanced ovarian cancer who underwent surgery between 2007 and 2021 as part of first‐line treatment were identified. Perioperative transfusion was defined as any transfusion from date of surgery to discharge from hospital. Multivariable Cox proportional hazards regression models were used to determine if there was an independent association of transfusion with all‐cause mortality, accounting significant confounders.ResultsA total of 5891 patients had cytoreductive surgery for advanced ovarian cancer between 2007 and 2021, of which 2898 (49.2%) had interval cytoreductive surgery (ICS) and 2993 (50.8%) had primary cytoreductive surgery (PCS). Perioperative blood transfusion was given to 37.3% of patients (40.5% ICS and 34.2% PCS). On multivariable analysis, there was an increased hazard of all‐cause mortality for patients receiving perioperative transfusion compared to those who did not (hazard ratio: 1.28; 95% CI: 1.20–1.37). The association of increased all‐cause mortality was observed starting 1 year after surgery, was sustained thereafter, and seen in both ICS and PCS groups.ConclusionPerioperative blood transfusion after cytoreductive surgery for ovarian cancer is common in Ontario, Canada and was significantly associated with an increase in all‐cause mortality. Blood transfusion is a poor prognostic factor, and the negative impact of blood transfusion persists beyond the immediate postoperative period.

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The impact of perioperative transfusions on the oncologic outcomes of patients with ovarian cancer: A population‐based study

Bouchard‐Fortier,

Gien,

Chan

et al. 2024

Journal of Surgical Oncology

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Shifting trends and sicker patients: Reassessing hysterectomy performed for benign indications by gynecologic oncologists

Wang,

Foley,

Blank

et al. 2024

Gynecologic Oncology

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Low serum creatinine levels are associated with major post-operative complications in patients undergoing surgery with gynecologic oncologists

Wang,

Bharadwa,

Foley

et al. 2024

Int J Gynecol Cancer

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ObjectiveSerum creatinine is a byproduct of muscle metabolism, and low creatinine is postulated to be associated with diminished muscle mass. This study examined the association between low pre-operative serum creatinine and post-operative outcomes.MethodsThis retrospective cohort study utilized the 2014–2021 National Surgical Quality Improvement Program to identify patients undergoing surgery with gynecologic oncologists. Patients with missing pre-operative creatinine, end-stage renal disease, sepsis, septic shock, dialysis, or pregnancy were excluded. Pre-operative creatinine was categorized into markedly low (≤0.44 mg/dL), mildly low (0.45–0.64 mg/dL), normal (0.65–0.84 mg/dL), and four categories of elevated levels (0.85–1.04, 1.05–1.24, 1.25–1.44, and ≥1.45 mg/dL). Outcomes included major (≥Grade 3) 30-day complications, categorized into any complications, wound, cardiovascular and pulmonary, renal, infectious, and thromboembolic complications. Also examined were 30-day readmissions, reoperations, and mortality. Logistic regressions assessed the association between creatinine and complications, with stratification by albumin and sensitivity analysis with propensity score matching.ResultsAmong 84 786 patients, 0.8% had markedly low, 19.6% mildly low, and 50.2% normal creatinine; the remainder had elevated creatinine. As creatinine decreased, the risks of major complications increased in a dose-dependent manner on univariable and multivariable analyses. A total of 9.6% (n=63) markedly low patients experienced major complications, second to creatinine ≥1.45 mg/dL (9.9%, n=141). On multivariable models, both markedly and mildly low creatinine were associated with higher odds of major complications (OR 1.715, 95% CI 1.299 to 2.264 and OR 1.093, 95% CI 1.001 to 1.193) and infections (OR 1.575, 95% CI 1.118 to 2.218 and OR 1.165, 95% CI 1.048 to 1.296) versus normal. Markedly low creatinine had similar ORs to creatinine ≥1.45 mg/dL and was further associated with higher odds of cardiovascular and pulmonary complications (OR 2.301, 95% CI 1.300 to 4.071), readmissions (OR 1.403, 95% CI 1.045 to 1.884), and mortality (OR 2.718, 95% CI 1.050 to 7.031). After albumin stratification, associations persisted for markedly low creatinine. Propensity-weighted analyses demonstrated congruent findings.ConclusionsLow creatinine levels are associated with major post-operative complications in gynecologic oncology in a dose-dependent manner. Low creatinine can offer useful information for pre-operative risk stratification, surgical counseling, and peri-operative management.

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Characterization of pre-operative anemia in patients undergoing surgery by a gynecologic oncologist and association with post-operative complications

Cited by 4 publications

References 34 publications

The impact of perioperative transfusions on the oncologic outcomes of patients with ovarian cancer: A population‐based study

The impact of perioperative transfusions on the oncologic outcomes of patients with ovarian cancer: A population‐based study

Shifting trends and sicker patients: Reassessing hysterectomy performed for benign indications by gynecologic oncologists

Low serum creatinine levels are associated with major post-operative complications in patients undergoing surgery with gynecologic oncologists

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