Predictors of complications and hospital stay in gynecologic cancer surgery

https://doi.org/10.1016/S0029-7844(00)01198-4Get rights and content

Abstract

Objective: To test the hypothesis that comorbid medical conditions can predict length of hospital stay and incidence of postoperative complications.

Methods: We reviewed the medical records of 187 women who had surgery for known or suspected gynecologic malignancies during 1996 and 1997, and 179 were included in the present study. Information on each woman’s comorbid medical conditions, surgical history, surgicopathologic cancer diagnosis, American Society of Anesthesiologists’ classification, surgical procedures, and postoperative complications was collected and analyzed.

Results: Women with two or more comorbid medical conditions had significantly longer mean hospital stays (8.62 days) than those with none or one comorbid medical condition (6.43 days) (P < .001). Women with two or more postoperative complications had significantly longer mean hospital stays (11.88 days) than those with none or one complication (6.02 days) (P < .001). Women with two or more postoperative complications also had significantly more comorbid medical conditions (mean 2.5) than those with none or one complication (mean 1.7) (P < .001). The American Society of Anesthesiologists class also was a significant predictor of postoperative complications and length of hospitalization. Age over 60 years also was associated with statistically significant increase in comorbid medical conditions and significantly longer hospitalizations.

Conclusion: Our findings indicated that certain high-risk patients can be identified before hospital admission based on comorbid medical conditions. Certain risk indices, such as the American Society of Anesthesiologists classification score, also can predict postoperative complications and length of hospital stay. This information can be used to coordinate preoperative and postoperative hospital care and be a reference for certain future disease management systems.

Section snippets

Materials and methods

The study included all women who had surgery for gynecologic malignancies from January 1, 1996 until December 31, 1997. One hundred eighty-seven women had invasive cancer; and eight were excluded because of incomplete medical records. The medical records of the remaining 179 women were extracted and reviewed. Data were recorded on a specifically designed data form. Admission comorbid medical conditions, surgical histories, and histories of radiation or chemotherapy were recorded, as was age,

Results

Table 1 shows descriptive data. The median American Society of Anesthesiologists class for the study group was 2 (range 1–4). One hundred ninety-six postoperative complications occurred in the study group (mean 1.09 ± 1.18). The most common were blood transfusion (n = 45, 23.0%), ileus or small bowel obstruction (n = 45, 23.0%), infections (n = 39, 19.9%), and febrile illness that did not require antibiotics (n = 26, 13.3%). Cancer was diagnosed in 179 women. Specific types are listed in Table 1

Discussion

We found that the number of comorbid medical conditions can predict length of hospitalization and frequency of postoperative complications. It was not surprising that women with more comorbid medical conditions had longer hospitalizations. There was a difference between having no or only one comorbid condition and having two or more comorbid conditions. That same relationship also was found in the postoperative complication rate. As expected, women with two or more postoperative complications

References (13)

There are more references available in the full text version of this article.

Cited by (0)

View full text
Copyright © 2001 The American College of Obstetricians and Gynecologists. Published by Elsevier Inc. All rights reserved.