Is there a need for consultant team for bowel resection? An evaluation of surgical outcomes of bowel resection at time of ovarian cytoreductive surgery

Abstract

<h3>Objectives:</h3> Bowel resections (BR) performed at the time of ovarian cytoreductive surgery (OCS) may be necessary to achieve optimal tumor resection rates; however BR has been associated with increased postoperative morbidity. The aims of this study were to determine the proportion of BR performed by the primary gynecologic oncology team versus another consultant team during OCS, and to compare the postoperative surgical outcomes between OCS with BR performed by either the primary or consultant teams. <h3>Methods:</h3> Women who underwent BR at time of OCS from 2013 to 2018 were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database using corresponding CPT, ICD-9, and ICD-10 codes. Determination of which surgical team performed the BR was based upon the surgical specialty of the primary team and whether the resection was coded as a primary or concurrent procedure. Comparative analyses were then stratified by surgical team to evaluate demographics, preoperative and intraoperative variables, and surgical outcomes. Statistical tests were performed with R Studio v.1.1.456. <h3>Results:</h3> A total of 8,750 women who underwent OCS were identified, and 1,784 (20.4%) of these women underwent a concurrent BR. Among the women who had a BR, 1,479 (82.9%) were performed by the primary team and 304 (17.0%) by a consultant team. Data was not available for one patient, and she was excluded from the analysis. Between the groups, there were no significant baseline differences in patient age, body mass index, preoperative functional status, American Society of Anesthesiology (ASA) class, and albumin and hematocrit levels. The two groups had similar operative times, total relative value units, and total lengths of hospital stay. More stomas were created when a consultant team performed the bowel resection (36.1% vs. 26.8%, p=0.002). When evaluating for the incidence of superficial, deep, and organ space infections separately, there were no differences between the two groups (Table 1). There were also no significant differences in reoperation, readmission, and death rates within the 30-day postoperative period. <h3>Conclusions:</h3> Routine consultation for BR may not result in improved surgical outcomes. There were no major differences in overall complications within the 30-day postoperative period whether the primary or a consultant team performed the BR. When a separate team was consulted to perform the BR during OCS, there were higher rates of stoma creation. Given the known morbidities associated with stoma creation, such as volume dehydration and electrolyte abnormalities, more stomas in this patient population could have an overall detrimental impact on quality of life that is not captured in the NSQIP database.