Davidson ER, et al. - This study was performed to compare the incidence of perioperative adverse events (AE) in women undergoing concurrent urogynecologic and gynecologic oncology (Gyn Onc) surgery to those undergoing Gyn Onc procedures alone. In addition, researchers delineated the frequency of abandonment or modification of the planned urogynecologic procedure in concurrent cases at their institution. Findings revealed no increased incidence of intraoperative or serious postoperative AE among women undergoing concurrent urogynecologic and Gyn Onc procedures. However, these women showed an increased frequency of minor AE. Moreover, at the time of GYN ONC surgery, one in ten planned urogynecologic procedures was either modified or abandoned.

Methods

• Researchers performed a retrospective matched cohort study of patients who underwent concurrent urogynecologic and Gyn Onc surgery at a large tertiary care center between January 2004 and June 2017.
• In accordance to surgeon, surgery date, surgery route, and final pathologic diagnosis, cohorts were matched.
• They used a 2:1 matching ratio to achieve adequate power to detect a 20% difference in AE between the groups.
• On identification of cohorts, they queried the medical record for demographic and perioperative and postoperative data.
• The Dindo scoring system was used to classify postoperative AE.

Results

• Concurrent procedures were performed on 108 patients, and 216 patients comprised the matched cohort.
• Benign (51%) or uterine cancer (36%) were the majority of the pathologic diagnoses.
• Concurrent cases were more often older, postmenopausal, have a higher vaginal parity, have received preoperative chemotherapy, and have a history of cardiac disease.
• Longer operating times and larger blood loss were evident among concurrent cases: 186.5 vs 110 minutes, p=0.0002 and 150 vs 67.5 mL, p < 0.0001.
• The groups showed no differences in intraoperative complications or serious AE (Dindo Grade ≥3).
• However, a Dindo Grade 2 adverse event was more frequently observed among concurrent cases (44% vs 19%, p < 0.0001); Dindo Grade 2 adverse events included postoperative UTI (26% vs 7%, p < 0.0001), blood transfusion (9% vs 3%, p=0.02), and pulmonary complication (7% vs 2%, p=0.03).
• On multivariate analysis, a higher rate of Dindo Grade ≥2 events were observed in association with concurrent surgery (adj OR = 2.63, 95% CI = 1.47-4.7, p=0.001) and postmenopausal status (adj OR = 2.36, 95% CI = 1.09-5.15, p=0.03).
• After concurrent procedures, higher incidence of discharge home with a Foley catheter was observed (35% vs 2%, p < 0.0001).
• In 10% (n = 11) of the concurrent cases, the planned urogynecologic procedure was significantly changed or aborted: 5 procedures due to intraoperative complications, 3 due to technical limitations, and 3 for oncologic indications (eg, need for radiotherapy).