Preoperative quality of life and surgical outcomes in gynecologic oncology patients: A new predictor of operative risk?

• Published in: Gynecologic oncology 2014-06, Vol.133 (3), p.546-551
• Main Authors: Doll, K.M, Snavely, A.C, Kalinowski, A, Irwin, D.E, Bensen, J.T, Bae-Jump, V, Boggess, J.F, Soper, J.T, Brewster, W.R, Gehrig, P.A
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Cohort Studies; Emergency Service, Hospital - utilization; Female; Genital Neoplasms, Female - surgery; Health Services - utilization; Hematology, Oncology and Palliative Medicine; Humans; Linear Models; Logistic Models; Middle Aged; Multivariate Analysis; Obstetrics and Gynecology; Odds Ratio; Patient Readmission - statistics & numerical data; Postoperative Complications - epidemiology; Postoperative recovery; Preoperative Period; Prospective Studies; Quality of Life; Surgical complications; Surveys and Questionnaires; Young Adult
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2014.04.002

Abstract Objective Quality of life (QoL) for women with gynecologic malignancies is predictive of chemotherapy related toxicity and overall survival but has not been studied in relation to surgical outcomes and hospital readmissions. Our goal was to evaluate the association between baseline, pre-operative QoL measures and 30-day post-operative morbidity and health resource utilization by gynecologic oncology patients. Methods We analyzed prospectively collected survey data from an institution-wide cohort study. Patients were enrolled from 8/2012 to 6/2013 and medical record data was abstracted (demographics, comorbid conditions, and operative outcomes). Responses from several validated health-related QoL instruments were collected. Bivariate tests and multivariable linear and logistic regression models were used to evaluate factors associated with QoL scores. Results Of 182 women with suspected gynecologic malignancies, 152 (84%) were surveyed pre-operatively and 148 (81%) underwent surgery. Uterine (94; 63.5%), ovarian (26; 17.5%), cervical (15; 10%), vulvar/vaginal (8; 5.4%), and other (5; 3.4%) cancers were represented. There were 37 (25%) cases of postoperative morbidity (PM), 18 (12%) unplanned ER visits, 9(6%) unplanned clinic visits, and 17 (11.5%) hospital readmissions (HR) within 30 days of surgery. On adjusted analysis, lower functional well-being scores resulted in increased odds of PM (OR 1.07, 95%CI 1.01–.1.21) and HR (OR 1.11, 95%CI 1.03–1.19). A subjective global assessment score was also strongly associated with HR (OR 1.89, 95%CI 1.14, 3.16). Conclusion Lower pre-operative QoL scores are significantly associated with post-operative morbidity and hospital readmission in gynecologic cancer patients. This relationship may be a novel indicator of operative risk.