Abstract
Introduction: The aim of this study is to provide a comprehensive 5-year audit of patients undergoing laparotomy for suspected or confirmed gynaecological malignancy to document the frequency and incidence of adverse events and to investigate factors associated with shorter length of stay and readmission to hospital. Methods: A 5-year surgical audit of the period commencing 2008 and concluding 2012. All patients undergoing laparotomy were included in the audit without exclusions. Approval was granted by the local Ethics Review Committee. Results: Four hundred and twenty-seven patients underwent laparotomy for suspected or confirmed gynaecological malignancy and were managed by Fast Track Surgery (FTS) principles. Average age was 54.8 years and average weight and BMI were 73.4 kg and 28.1 respectively. Ultimately 254 (59%) patients had confirmed malignancy. Average surgery duration was 2.36 hours and average estimated blood loss (EBL) at surgery was 262 mL. Median and mean LOS was 3.0 and 3.5 days respectively with 125 (29%) patients discharged on day 2. Overall transfusion rate was 5%. Other adverse events in decreasing frequency were hospital readmission (3.7%), significant wound infection (3%) and unplanned High Dependency Unit (HDU) admission (1.4%). All other adverse events were uncommon with rates
Highlights
The aim of this study is to provide a comprehensive 5-year audit of patients undergoing laparotomy for suspected or confirmed gynaecological malignancy to document the frequency and incidence of adverse events and to investigate factors associated with shorter length of stay and readmission to hospital
Average weight was 73.4 kg (Range: 38 - 192 kg), average body mass index (BMI) was 28.1 (Range: 16.9 - 68.8) with 260 (61%) patients classified as either overweight or obese
Two hundred and eighty one (66%) patients had zero performance status (PS) meaning they were fully active; 102 (24%) had a PS of 1 indicating restriction in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work, and 44 (10%) had a PS of 2 or 3 indicating they were ambulatory and capable of all self-care but unable to carry out any work activities (PS 2) or up and about more than 50% of waking hours or capable of only limited self-care, confined to bed or chair more than 50% of waking hours (PS 3)
Summary
The aim of this study is to provide a comprehensive 5-year audit of patients undergoing laparotomy for suspected or confirmed gynaecological malignancy to document the frequency and incidence of adverse events and to investigate factors associated with shorter length of stay and readmission to hospital. Factors associated with a short LOS included year of surgery, age, performance status, malignant vs benign pathology, the use of COX-2 inhibitors, operation time, incision type, transfusion, and radical hysterectomy, at least 1 complication, if patients tolerated early oral feeding (EOF). Conclusions: This 5-year audit is important in establishing a contemporary incidence and the prevalence rate of serious adverse events for patients with suspected or confirmed gynaecological cancer undergoing laparotomy and managed by FTS principles. The basic tenet of such programs is to enhance recovery after surgery, allowing earlier discharge with improved patient outcomes and low readmission rates. Such programs derive their success from being multidisciplinary with all members of the team having an important function. There is no long term published data on the safety and outcomes of such programs in gynaecological oncology
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