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Adverse Events After Concurrent Procedures for Gynecologic Malignancies and Pelvic Floor Disorders

Bretschneider, C. Emi, MD; Sheyn, David, MD; Mahajan, Sangeeta T., MD; Ferrando, Cecile A., MD, MPH

doi: 10.1097/AOG.0000000000002731
Contents: Gynecologic Surgery: Original Research

OBJECTIVE: To evaluate the incidence and trends of 30-day outcomes after concurrent surgeries for gynecologic cancer and pelvic floor disorders.

METHODS: Using the American College of Surgeons National Quality Improvement Program database, patients who underwent surgery for gynecologic cancer with and without pelvic floor reconstruction were identified between the years 2013 and 2016. Propensity score matching was performed to ameliorate selection. Student t test and Mann-Whitney tests were used to compare continuous variables between two groups where appropriate. The χ2 and Fisher exact tests were used where appropriate to compare categorical variables across groups. Logistic regression models were used to evaluate factors associated with any adverse event and with postoperative transfusion specifically.

RESULTS: Twenty-five thousand one hundred thirty-eight patients underwent oncologic surgery and 589 (2.3%) of these had concurrent pelvic reconstruction during the study period. After propensity matching, there were 488 combined cases; 976 oncologic-only cases were selected as controls. There were no statistically significant differences across any of the baseline characteristics between groups. Although more common in the combined than in the control cohort, the incidence of any postoperative adverse event (8.2% vs 5.5%, odds ratio [OR] 1.5, 95% CI 0.99–2.3) was not statistically significant between groups. Postoperative blood transfusions, however, were more common in the combined cohort than in the control cohort (7.2% vs 3.6%, OR 1.7, 95% CI 1.1–2.8). After logistic regression, ovarian cancer (adjusted OR 7.9, 95% CI 4.9–12.7) and prolapse surgery (adjusted OR 1.7, 95% CI 1.0–2.7) remained significantly associated with any postoperative adverse events. Similarly, ovarian cancer (adjusted OR 10.0, 95% CI 5.9–17.3) and prolapse surgery (adjusted OR 2.1, 95% CI 1.2–3.6) remained significantly associated with a higher incidence of postoperative blood transfusions.

CONCLUSION: Combined reconstructive and oncologic surgery is associated with a low but statistically significant increase in the risk of any postoperative adverse event and specifically blood transfusions.

Combined oncologic and reconstructive pelvic surgery is associated with higher complication rates compared with oncologic surgery alone.

Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology & Women's Health Institute, Cleveland Clinic, the Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University Hospitals Cleveland Medical Center, and Case Western Reserve University School of Medicine, Cleveland, Ohio.

Corresponding author: C. Emi Bretschneider, MD, Cleveland Clinic Foundation, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195; email:

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received February 23, 2018. Received in revised form April 23, 2018. Accepted May 3, 2018.

Received February 23, 2018

Received in revised form April 23, 2018

Accepted May 03, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.