Peri-operative cardiac events in patient undergoing surgery for gynecologic malignancies are associated with long-term cardiovascular outcomes (489)

Abstract

Objectives: Cardiovascular (CV) disease is a leading cause of mortality in older women, but there is limited data on women with gynecologic cancer. Cancer and CV disease have significant pathophysiologic overlap, and both independently increase the risk of the other. Cancer patients have a 5-fold increased risk of major stroke or myocardial infarction, and patients who have perioperative cardiac events in noncardiac surgeries have significantly increased mortality. We aimed to characterize the incidence of perioperative events and long-term outcomes in women undergoing surgery for gynecologic malignancy. Methods: A retrospective cohort analysis was performed from January 1, 2013, to December 31, 2019, of all patients with gynecologic malignancies who had either a perioperative (within 30 days of surgery) or subsequent cardiac event. Events were abstracted from the electronic medical record using ICD codes. Demographic, medical history, comorbid conditions, oncologic course, and event-based data were analyzed using SAS 9.4. Results: One hundred seventy-four patients met the inclusion criteria; 76 (45.3%) had ovarian cancer, 69 (40.0%) had uterine cancer, and 23 (13.7%) had cervical/vulvovaginal cancer. The average age was 67.4 years, 63.0% were white, 35.3% were Black, and 1.2% were Asian. Fifty-four (31.0%) patients experienced a perioperative CV event. Arrhythmia was most common (23.6%), followed by heart failure exacerbation (4.6%) and NSTEMI (4.6%). Of these patients, 35.2% had not been identified to be at increased cardiac risk preoperatively. Among the patients who had a perioperative event, 46.7% were diagnosed with a new chronic CV condition. After 30 days of follow-up, 45.4% of patients had a new CV event: arrhythmia was most common (17.8%), followed by heart failure exacerbation (16.7%) and stroke/ TIA (5.2%). Of these patients, 33 were diagnosed with at least one chronic CV condition, including heart failure (51.5%), atrial fibrillation (30.3%), CAD (6.1%), and pulmonary hypertension (6.1%). Fifteen patients who had perioperative events had a subsequent CV event. Conclusions: Perioperative cardiac events related to surgery for gynecologic malignancy, though rare, may represent a sentinel event for CV health and represent an opportunity for early intervention. Almost half of the patients with a CV event were diagnosed with a new chronic CV condition, and almost one-third had a subsequent CV event. Additional studies should focus on the long-term sequelae of perioperative CV events in gynecologic oncology patients and their interaction with oncologic outcomes. Objectives: Cardiovascular (CV) disease is a leading cause of mortality in older women, but there is limited data on women with gynecologic cancer. Cancer and CV disease have significant pathophysiologic overlap, and both independently increase the risk of the other. Cancer patients have a 5-fold increased risk of major stroke or myocardial infarction, and patients who have perioperative cardiac events in noncardiac surgeries have significantly increased mortality. We aimed to characterize the incidence of perioperative events and long-term outcomes in women undergoing surgery for gynecologic malignancy. Methods: A retrospective cohort analysis was performed from January 1, 2013, to December 31, 2019, of all patients with gynecologic malignancies who had either a perioperative (within 30 days of surgery) or subsequent cardiac event. Events were abstracted from the electronic medical record using ICD codes. Demographic, medical history, comorbid conditions, oncologic course, and event-based data were analyzed using SAS 9.4. Results: One hundred seventy-four patients met the inclusion criteria; 76 (45.3%) had ovarian cancer, 69 (40.0%) had uterine cancer, and 23 (13.7%) had cervical/vulvovaginal cancer. The average age was 67.4 years, 63.0% were white, 35.3% were Black, and 1.2% were Asian. Fifty-four (31.0%) patients experienced a perioperative CV event. Arrhythmia was most common (23.6%), followed by heart failure exacerbation (4.6%) and NSTEMI (4.6%). Of these patients, 35.2% had not been identified to be at increased cardiac risk preoperatively. Among the patients who had a perioperative event, 46.7% were diagnosed with a new chronic CV condition. After 30 days of follow-up, 45.4% of patients had a new CV event: arrhythmia was most common (17.8%), followed by heart failure exacerbation (16.7%) and stroke/ TIA (5.2%). Of these patients, 33 were diagnosed with at least one chronic CV condition, including heart failure (51.5%), atrial fibrillation (30.3%), CAD (6.1%), and pulmonary hypertension (6.1%). Fifteen patients who had perioperative events had a subsequent CV event. Conclusions: Perioperative cardiac events related to surgery for gynecologic malignancy, though rare, may represent a sentinel event for CV health and represent an opportunity for early intervention. Almost half of the patients with a CV event were diagnosed with a new chronic CV condition, and almost one-third had a subsequent CV event. Additional studies should focus on the long-term sequelae of perioperative CV events in gynecologic oncology patients and their interaction with oncologic outcomes.