Short‐term surgical complications after radical hysterectomy—A nationwide cohort study. (6th February 2020)

• Record Type: Journal Article
• Authors: Wenzel, Hans H. B.; Kruitwagen, Roy F. P. M.; Nijman, Hans W.; Bekkers, Ruud L. M.; van Gorp, Toon; de Kroon, Cornelis D.; van Lonkhuijzen, Luc R. C. W.; Massuger, Leon F. A. G.; Smolders, Ramon G. V.; van Trommel, Nienke E.; Yigit, Refika; Zweemer, Ronald P.; van der Aa, Maaike A.
• Is Part Of: Acta obstetricia et gynecologica Scandinavica. Volume 99:Number 7(2020)
• Page Start: 925
• Page End: 932
• Publication Date: 2020-02-06
• Subjects: hemorrhage -- hysterectomy -- intraoperative complications -- postoperative complications -- urinary retention -- uterine cervical neoplasms; Gynecology -- Periodicals; Pregnancy -- Periodicals; Obstetrics -- Periodicals; 618.05
• DOI: 10.1111/aogs.13812
• Languages: English
• ISSNs: 0001-6349

Abstract

Abstract: Introduction: Centralization has, among other aspects, been argued to have an impact on quality of care in terms of surgical morbidity. Next, monitoring quality of care is essential in identifying areas of improvement. This nationwide cohort study was conducted to determine the rate of short‐term surgical complications and to evaluate its possible predictors in women with early‐stage cervical cancer. Material and methods: Women diagnosed with early‐stage cervical cancer, 2009 FIGO stages IB1 and IIA1, between 2015 and 2017 who underwent radical hysterectomy with pelvic lymphadenectomy in 1 of the 9 specialized medical centers in the Netherlands, were identified from the Netherlands Cancer Registry. Women were excluded if primary treatment consisted of hysterectomy without parametrial dissection or radical trachelectomy. Women in whom radical hysterectomy was aborted during the procedure, were also excluded. Occurrence of intraoperative and postoperative complications and type of complications, developing within 30 days after surgery, were prospectively registered. Multivariable logistic regression analysis was used to identify predictors of surgical complications. Results: A total of 472 women were selected, of whom 166 (35%) developed surgical complications within 30 days after radical hysterectomy. The most frequent complications were urinary retention with catheterization in 73 women (15%) and excessive perioperative blood loss >1000 mL in 50 women (11%). Open surgery (odds ratio [OR] 3.42; 95% CI 1.73‐6.76), chronic pulmonary disease (OR 3.14; 95% CI 1.45‐6.79), vascular disease (OR 1.90; 95% CI 1.07‐3.38), and medical center (OR 2.83; 95% CI 1.18‐6.77) emerged as independent predictors of the occurrence of complications. Body mass index (OR 0.94; 95% CI 0.89‐1.00) was found as a negative predictor of urinary retention. Open surgery (OR 36.65; 95% CI 7.10‐189.12) and body mass index (OR 1.15; 95% CI 1.08‐1.22) were found to be independent predictors of excessive perioperative blood loss. Conclusions: Short‐term surgical complications developed in 35% of the women after radical hysterectomy for early‐stage cervical cancer in the Netherlands, a nation with centralized surgical care. Comorbidities predict surgical complications, and open surgery is associated with excessive perioperative blood loss.