Article

Postoperative complications after gynecologic surgery.

Yale University School of Medicine, New Haven, CT, USA.
Obstetrics and Gynecology (Impact Factor: 4.8). 10/2011; 118(4):785-93. DOI: 10.1097/AOG.0b013e31822dac5d
Source: PubMed

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

1 Bookmark
 · 
115 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine factors predictive of bowel complications after gynecologic surgery and establish the added utility of computed tomography (CT) in the diagnostic process. Patients who underwent gynecologic surgery between January 2, 2008, and December 30, 2010, who had CT scans of the abdomen, pelvis, or abdomen and pelvis within 42 days for a suspected bowel complication were identified. Logistic regression analysis was used to identify factors predictive of bowel-related complications. The diagnostic accuracy of CT was compared among patient risk groups based on clinical suspicion (pretest probability) of bowel complications. Among 205 eligible patients, 38 (18.5%) patients had a bowel-related complication. Mean time from surgery to CT was 12.4 (10.1) days. Clinical characteristics were used to develop a clinical model that included unexpected drainage from the drain, wound, or stoma (adjusted odds ratio [OR] 26.3, 95% confidence interval [CI] 3.1-224.4, P=.003), coronary artery disease (OR 10.7, CI 1.4-80.9, P=.022), laparotomy (compared with minimally invasive surgery) (OR 4.4, CI 1.1-17.2, P=.032), and age older than 45 years (OR 2.4, CI 0.7-8.8, P=.18). Addition of CT to clinical evaluation increased the predictive ability of the model (area under the curve) from 0.73 to 0.99. Among 57 low-risk patients, three with confirmed bowel-related complications would have been missed if CT was not performed. Among 13 high-risk patients, CT sensitivity was 70%, and it was negative for bowel complications in three patients subsequently confirmed to have serious complications (one anastomotic leak, two bowel perforations). In patients who have undergone gynecologic surgery and have a high clinical probability of a postoperative bowel-related complication, CT alone may fail to accurately identify patients with serious complications. LEVEL OF EVIDENCE:: II.
    Obstetrics and Gynecology 11/2013; · 4.80 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Colpocleisis is not a popular option amongst surgeons, possibly due to concern about long-term regret. This study assessed a cohort of women who underwent colpocleisis 2-5 years previously to determine the regret rate, the effect on quality of life (QOL) and bladder and bowel function. This was a longitudinal study of patients who underwent colpocleisis at least 2 years previously. Participants were asked to complete the Prolapse QOL (P-QOL), International Consultation on Incontinence-Urinary Incontinence (ICIQ-UI Short Form) and Colorectal Anal Distress Inventory questionnaires (CRADI). Two additional questions were asked: (1) Do you regret having vaginal closure surgery for prolapse? (never, sometimes, often, all the time), and (2) Would you recommend this surgery to a relative or friend who is not sexually active? (yes, no.) RESULTS: Thirty-four women were identified. Six had died by the time of follow-up, and five declined to answer the questionnaires because of ill health. Twenty-three women responded (67 %). Mean age was 78.68 years. One woman regretted having had the surgery, as the colpocleisis had failed. Twenty-one women (91.3 %) would recommend this surgery; one would not (4.3 %), and another was not sure (4.5 %). Low P-QOL [8 (0-37) ± 9.41), ICIQ-UI (7 (0-17) ± 5.44) and CRADI (10; 0-28 ± 8.13] scores suggest a positive impact on QOL, bladder and bowel function. In this cohort, colpocleisis produced a good outcome with low regret rate (4.3 %), good QOL and minimal effect on bladder and bowel function at 2-5 years.
    International Urogynecology Journal 01/2014; · 2.17 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To estimate the lifetime risk of stress urinary incontinence (SUI) surgery, pelvic organ prolapse (POP) surgery, or both using current, population-based surgical rates from 2007 to 2011. We used a 2007-2011 U.S. claims and encounters database. We included women aged 18-89 years and estimated age-specific incidence rates and cumulative incidence (lifetime risk) of SUI surgery, POP surgery, and either incontinence or prolapse surgery with 95% confidence intervals (CIs). We estimated lifetime risk until the age of 80 years to be consistent with prior studies. From 2007 to 2011, we evaluated 10,177,480 adult women who were followed for 24,979,447 person-years. Among these women, we identified 65,397 incident, or first, SUI and 57,755 incident prolapse surgeries. Overall, we found that the lifetime risk of any primary surgery for SUI or POP was 20.0% (95% CI 19.9-20.2) by the age of 80 years. Separately, the cumulative risk for SUI surgery was 13.6% (95% CI 13.5-13.7) and that for POP surgery was 12.6% (95% CI 12.4-2.7). For age-specific annual risk, SUI demonstrated a bimodal peak at age 46 years and then again at age 70-71 years with annual risks of 3.8 and 3.9 per 1,000 women, respectively. For POP, the risk increased progressively until ages 71 and 73 years when the annual risk was 4.3 per 1,000 women. Based on a U.S. claims and encounters database, the estimated lifetime risk of surgery for either SUI or POP in women is 20.0% by the age of 80 years. LEVEL OF EVIDENCE:: III.
    Obstetrics and Gynecology 05/2014; · 4.80 Impact Factor

Full-text

View
3 Downloads
Available from