Bretschneider CE, et al. - Using the American College of Surgeons National Quality Improvement Program database, researchers determined the incidence and trends of 30-day outcomes after concurrent surgeries for gynecologic cancer and pelvic floor disorders. Findings revealed a low but statistically significant increase in the risk of any postoperative adverse event and specifically blood transfusion in relation to combined reconstructive and oncologic surgery.

Methods

• From the years 2013 to 2016, researchers identified patients who underwent surgery for gynecologic cancer with and without pelvic floor reconstruction using the American College of Surgeons National Quality Improvement Program database.
• They performed propensity score matching to ameliorate selection.
• Where appropriate, continuous variables between two groups were compared using student t test and Mann-Whitney tests.
• Categorical variables were compared across groups, using the X² and Fisher exact tests, where appropriate.
• Factors associated with any adverse event and with postoperative transfusion specifically were identified using logistic regression models.

Results

• Of the 25,138 patients undergoing oncologic surgery, 589 (2.3%) had concurrent pelvic reconstruction during the study period.
• Propensity matching led to identification of 488 combined cases; researchers selected 976 oncologic-only cases as controls.
• The groups were not statistically significantly different across any of the baseline characteristics.
• The groups had no statistically significant differences in terms of the incidence of any postoperative adverse event, although these were more common in the combined than in the control cohort (8.2% vs 5.5%, odds ratio [OR] 1.5, 95% CI 0.99–2.3).
• However, the combined cohort had more frequent postoperative blood transfusions than the control cohort (7.2% vs 3.6%, OR 1.7, 95% CI 1.1–2.8).
• Using logistic regression, they identified a significant association of 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) with any postoperative adverse events.
• Similarly, a higher incidence of postoperative blood transfusions was observed in significant association with 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).