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

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-ope...

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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
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Summary: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.
ISSN:0090-8258
1095-6859
DOI:10.1016/j.ygyno.2014.04.002