Risk factors associated with 30-day postoperative complications following contemporary pelvic exenterations for gynecologic cancer

Objectives: Pelvic exenteration (PE) is an uncommon radical procedure associated with high perioperative morbidity due to the nature and extent of surgery. Due to surgical innovation and perioperative care advances, postoperative outcomes may have improved for PE. The purpose of this study is to evaluate rates of 30-day postoperative complications (POC) and risk factors associated with POC following PE for gynecologic malignancies. Methods: Data was obtained from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. All patients who underwent PE for a gynecologic cancer from 2012-2018 were identified using appropriate CPT, ICD-9 and ICD-10 codes. Comparative analyses were performed and stratified by admission status to evaluate demographics, preoperative and intraoperative variables, and surgical outcomes. Statistical tests were performed with R Studio v.1.1.456. Results: Between 2012-2018, 473 patients who had undergone a PE for a gynecologic malignancy were identified. The median age at time of surgery was 59 years (range, 22-90 years) and median body mass index (BMI) was 26.1 kg/m2 (range, 15.5-65.7 kg/m2). The median operative time was 385 minutes (range, 55-1090 minutes). At the time of their PE, 21.2% of patients underwent a concurrent myocutaneous flap and 12.3% a urinary conduit. The median length of hospital stay was 10 days (range, 0-114 days). At time of discharge, 79.2% were discharged home, 20.4% were transferred to an acute care or rehab facility, and 0.4% expired. The overall POC rate was 75.9%, but when urinary tract infections and blood transfusions were excluded, the POC rate was 37.6%. The 30-day readmission rate was 20.3% and re-operation rate was 10.4%. Lower preoperative albumin and hematocrit values, longer operative times, higher American Society of Anesthesiology (ASA) class, concurrent flap, and urinary conduit procedures were associated with higher POC rates (Table 1). When adjusting for these factors on multivariate analysis, preoperative albumin levels, and longer operative times remained independent risk factors for higher POC rates. Download : Download high-res image (123KB) Download : Download full-size image Conclusions: There remains a high rate of 30-day POC following PE; although a significant proportion of the POC are driven by the development of urinary tract infections and administration of blood transfusions. The contemporary mortality rate appears to be lower than previously reported historical rates. Preoperative albumin levels and longer operative times may be modifiable risk factors that can reduce POC rates.