Prediction of short-term surgical complications in women undergoing pelvic exenteration for gynecological malignancies

L. Tortorella, J. Casarin, K. C. Mara, A. L. Weaver, F. Multinu, G. E. Glaser, William Arthur Cliby, G. Scambia, A. Mariani, A. Kumar

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: Pelvic exenteration (PE) is an extensive surgery associated with high rates of postoperative morbidity and mortality. The absence of well-defined preoperative selection criteria to identify patients eligible for PE prompted the assessment of pre-operative predictors of 30-day major surgical complications. Methods: Demographics and surgical characteristics of patients undergoing PE for gynecologic cancer in a single institution between 01/2004–12/2016 were reviewed. Postoperative complications within 30 days following surgery were graded using the Accordion grading system. Logistic regression was used to analyze potential risk factors for severe postoperative complications. Results: A total of 138 patients were included in the cohort. Forty-five patients underwent total PE, 52 anterior PE, and 41 posterior PE. Among the 137 patients with follow-up, a severe postoperative complication was experienced by 37 patients (27.0%) and 3 patients (2.2%) experienced death within 90 days. The most frequent grade 3 complications were complications of urinary reconstruction (n = 15), wound dehiscence (n = 9), and abdominal abscess requiring intervention with drain or return to the operating room (n = 6). On multivariable analysis, independent predictors of severe postoperative complications were anterior or total PE (adjusted odds ratio (aOR): 11.66, 95% CI 2.56–53.18), pre-operative hemoglobin ≤10 mg/dl (aOR 2.70, 95% CI 1.02–7.14) and presence of 3+ comorbidities (aOR: 2.76, 95% CI 1.07–7.10). Conclusions: Major complications after exenteration are common. Surgical complexity and patient selection play a considerable role in predicting complications. These data can be used to better risk stratify patients undergoing PE.

Original languageEnglish (US)
JournalGynecologic Oncology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Pelvic Exenteration
Neoplasms
Odds Ratio
Patient Selection
Abdominal Abscess
Operating Rooms
Ambulatory Surgical Procedures
Comorbidity
Hemoglobins
Logistic Models
Demography
Morbidity
Mortality

Keywords

  • Gynecological cancer
  • Pelvic Exenteration
  • Surgical 30-day complications

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

Cite this

Tortorella, L., Casarin, J., Mara, K. C., Weaver, A. L., Multinu, F., Glaser, G. E., ... Kumar, A. (Accepted/In press). Prediction of short-term surgical complications in women undergoing pelvic exenteration for gynecological malignancies. Gynecologic Oncology. https://doi.org/10.1016/j.ygyno.2018.10.036

Prediction of short-term surgical complications in women undergoing pelvic exenteration for gynecological malignancies. / Tortorella, L.; Casarin, J.; Mara, K. C.; Weaver, A. L.; Multinu, F.; Glaser, G. E.; Cliby, William Arthur; Scambia, G.; Mariani, A.; Kumar, A.

In: Gynecologic Oncology, 01.01.2018.

Research output: Contribution to journalArticle

Tortorella, L. ; Casarin, J. ; Mara, K. C. ; Weaver, A. L. ; Multinu, F. ; Glaser, G. E. ; Cliby, William Arthur ; Scambia, G. ; Mariani, A. ; Kumar, A. / Prediction of short-term surgical complications in women undergoing pelvic exenteration for gynecological malignancies. In: Gynecologic Oncology. 2018.
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abstract = "Objective: Pelvic exenteration (PE) is an extensive surgery associated with high rates of postoperative morbidity and mortality. The absence of well-defined preoperative selection criteria to identify patients eligible for PE prompted the assessment of pre-operative predictors of 30-day major surgical complications. Methods: Demographics and surgical characteristics of patients undergoing PE for gynecologic cancer in a single institution between 01/2004–12/2016 were reviewed. Postoperative complications within 30 days following surgery were graded using the Accordion grading system. Logistic regression was used to analyze potential risk factors for severe postoperative complications. Results: A total of 138 patients were included in the cohort. Forty-five patients underwent total PE, 52 anterior PE, and 41 posterior PE. Among the 137 patients with follow-up, a severe postoperative complication was experienced by 37 patients (27.0{\%}) and 3 patients (2.2{\%}) experienced death within 90 days. The most frequent grade 3 complications were complications of urinary reconstruction (n = 15), wound dehiscence (n = 9), and abdominal abscess requiring intervention with drain or return to the operating room (n = 6). On multivariable analysis, independent predictors of severe postoperative complications were anterior or total PE (adjusted odds ratio (aOR): 11.66, 95{\%} CI 2.56–53.18), pre-operative hemoglobin ≤10 mg/dl (aOR 2.70, 95{\%} CI 1.02–7.14) and presence of 3+ comorbidities (aOR: 2.76, 95{\%} CI 1.07–7.10). Conclusions: Major complications after exenteration are common. Surgical complexity and patient selection play a considerable role in predicting complications. These data can be used to better risk stratify patients undergoing PE.",
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AU - Tortorella, L.

AU - Casarin, J.

AU - Mara, K. C.

AU - Weaver, A. L.

AU - Multinu, F.

AU - Glaser, G. E.

AU - Cliby, William Arthur

AU - Scambia, G.

AU - Mariani, A.

AU - Kumar, A.

PY - 2018/1/1

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N2 - Objective: Pelvic exenteration (PE) is an extensive surgery associated with high rates of postoperative morbidity and mortality. The absence of well-defined preoperative selection criteria to identify patients eligible for PE prompted the assessment of pre-operative predictors of 30-day major surgical complications. Methods: Demographics and surgical characteristics of patients undergoing PE for gynecologic cancer in a single institution between 01/2004–12/2016 were reviewed. Postoperative complications within 30 days following surgery were graded using the Accordion grading system. Logistic regression was used to analyze potential risk factors for severe postoperative complications. Results: A total of 138 patients were included in the cohort. Forty-five patients underwent total PE, 52 anterior PE, and 41 posterior PE. Among the 137 patients with follow-up, a severe postoperative complication was experienced by 37 patients (27.0%) and 3 patients (2.2%) experienced death within 90 days. The most frequent grade 3 complications were complications of urinary reconstruction (n = 15), wound dehiscence (n = 9), and abdominal abscess requiring intervention with drain or return to the operating room (n = 6). On multivariable analysis, independent predictors of severe postoperative complications were anterior or total PE (adjusted odds ratio (aOR): 11.66, 95% CI 2.56–53.18), pre-operative hemoglobin ≤10 mg/dl (aOR 2.70, 95% CI 1.02–7.14) and presence of 3+ comorbidities (aOR: 2.76, 95% CI 1.07–7.10). Conclusions: Major complications after exenteration are common. Surgical complexity and patient selection play a considerable role in predicting complications. These data can be used to better risk stratify patients undergoing PE.

AB - Objective: Pelvic exenteration (PE) is an extensive surgery associated with high rates of postoperative morbidity and mortality. The absence of well-defined preoperative selection criteria to identify patients eligible for PE prompted the assessment of pre-operative predictors of 30-day major surgical complications. Methods: Demographics and surgical characteristics of patients undergoing PE for gynecologic cancer in a single institution between 01/2004–12/2016 were reviewed. Postoperative complications within 30 days following surgery were graded using the Accordion grading system. Logistic regression was used to analyze potential risk factors for severe postoperative complications. Results: A total of 138 patients were included in the cohort. Forty-five patients underwent total PE, 52 anterior PE, and 41 posterior PE. Among the 137 patients with follow-up, a severe postoperative complication was experienced by 37 patients (27.0%) and 3 patients (2.2%) experienced death within 90 days. The most frequent grade 3 complications were complications of urinary reconstruction (n = 15), wound dehiscence (n = 9), and abdominal abscess requiring intervention with drain or return to the operating room (n = 6). On multivariable analysis, independent predictors of severe postoperative complications were anterior or total PE (adjusted odds ratio (aOR): 11.66, 95% CI 2.56–53.18), pre-operative hemoglobin ≤10 mg/dl (aOR 2.70, 95% CI 1.02–7.14) and presence of 3+ comorbidities (aOR: 2.76, 95% CI 1.07–7.10). Conclusions: Major complications after exenteration are common. Surgical complexity and patient selection play a considerable role in predicting complications. These data can be used to better risk stratify patients undergoing PE.

KW - Gynecological cancer

KW - Pelvic Exenteration

KW - Surgical 30-day complications

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