Perioperative Morbidity and Mortality in patients with Gynaecological cancer: A cancer centre experience

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Perioperative Morbidity and Mortality in patients with
Gynaecological cancer: A cancer centre experience
V Asher, L Craciunas, R Slade, M Smith, B Winter-Roach, A Ahmed
Christie Hospital, Manchester
Aim
We assessed the
perioperative morbidity
and mortality of
patients undergoing
major gynaecological
oncology surgery at
the Christie Hospital, a
cancer centre and
compared it with the
UKGOSOC national
audit.
Results
A total of 117 major surgeries were
performed
Conclusion
Christie hospital is one of the two centre's in the UK for the management of psuedomyoma peritonei cases. The
perioperative morbidity and mortality for gynaecological cancer patients at our centre compares favourably with the
national average. This is primarily due to a multidisciplinary approach with good support by an experienced colorectal
team and presence of level 3 critical care unit.
References 1. Angiolo Gadducci, Stefania Cosio, Nicoletta Spirito, Andrea Riccardo Genazzani. Critical Reviews in Oncology/Hematology 2010;73:126–140.
2. S. R. Moonesinghe and A. A. Tomlinson. BJA 2011;106(4): 447-50
3. Liberating the NHS: Transparency in Outcomes—A Framework for
the NHS. Department of Health. 2010
Introduction
Major surgery remains the
cornerstone for patients with
gynaecological cancer and
can be associated with
significant morbidity and
mortality1. Recording of
perioperative morbidity and
mortality data helps to
assess the quality of care
and acts a summary
measure of performance of
the institution2. Moreover it
also provides data for the
purposes of benchmarking,
improving standards, and
determining payment
to health-care providers as
set out by the Department of
Health in the White paper3.
These outcome measures
have been suggested as
part of the annual appraisal
for the Gynaecological
oncologist and will be central
to revalidation in the UK.
Also, collection of this data
provides information for the
patients undergoing these
procedures and forms the
basis of informed consent.
.
Method
Prospective morbidity
and mortality data of
all patients undergoing
major surgery for
gynaecological cancer
from Jan to Dec 2011
was collected and the
analysed using Excel
spreadsheet.
Approach
4(3.4%)
7(5.9%)
Intraoperative complications
Post operative complications
Medical
Minor surgical
Major surgical
3 (2.5%)
1 (0.8%)
7 (5.9%)
Other measures
Mortality: 0
Hospital Re-Admission: 1 (0.8%)
Unexpected ITU admission: 3 (2.5%) All were
for AF
Return to theatres: 0
Unplanned blood transfusion: 7 (5.8%)
Intra operave
complicaons
Chrise UKGOSOC
Overall 3.4% 4.9%
UKGOSOC
Prospective UK audit looking at morbidity in
patients undergoing surgery for
gynaecological cancers from 1st April 2010
to 31st July 2011 in 10 centres and 1669
operations were performed.
Post op
complicaons
Chrise UKGOSOC
Minor 5.9% 11.1%
Major 0.8% 4.7%
Overall Chrise UKGOSOC
Mortality 0 1.85%
Return to
theatre
0 2.3%
Readmission 0.8% 1.6%
Major intraoperative complications
Minor- Grade1 and 2 Major- Grade3,4 & 5
Grade 1 Mild; asymptomatic or mild
symptoms; clinical or diagnostic observations only; intervention not
indicated.
Grade 2 Moderate; minimal, local or noninvasive intervention
indicated; limiting age-appropriate instrumental Activities of daily
living (ADL).
Grade 3 Severe or medically significant but not immediately life-
threatening; hospitalization or prolongation of hospitalization
indicated; disabling; limiting self care ADL.
Grade 4 Life-threatening consequences; urgent intervention
indicated.
Grade 5 Death related to procedure..
Grading of complications was done
according to NCI –CTCAE classification
Post operative complications