Objective
To estimate the association of age, medical comorbidities, functional status, and unintentional weight loss (as a marker of frailty) with postoperative complications in women undergoing major gynecologic surgery.
Methods
We conducted a cross-sectional analysis of the American College of Surgeons National Surgical Quality Improvement Program 2005-2009 participant use data files were used to analyze gynecologic procedures. The primary outcome was composite 30-day major postoperative complications.
Results
A total of 22,214 women were included in our final analysis. The overall prevalence of composite 30 day major postoperative complications was 3.7% (n=817). Age 80 years or older (adjusted odds ratio (OR)=1.8(95% Confidence Interval (CI) 1.25,2.58)), dependent functional status (adjusted OR= 2.37(95% CI 1.53,3.68)), and unintentional weight loss (adjusted OR = 2.49(95% CI 1.48,4.17)) were significantly associated with postoperative morbidity after adjusting for diabetes mellitus (adjusted OR= 1.44(95% CI 1.15,1.79)), known bleeding disorder (adjusted OR= 2.29 (95% 1.49,3.52)), morbid obesity (adjusted OR= 1.77(95% CI 1.45,2.17)), ascites (adjusted OR= 3.27(95% CI 2.18,4.90)), preoperative systemic infection (adjusted OR= 3.02(95% CI 2.03,4.48)), procedures for gynecologic cancer (adjusted OR= 1.60(95% CI 1.27,2.0)), disseminated cancer (adjusted OR= 2.57(95% CI 1.64,4.03)), emergency procedures (adjusted OR = 1.82(95% CI 1.18,2.79)), operative time greater than 4 hours vs. less than 1 hour (adjusted OR = 2.91(95%CI 2.18,3.89)) and wound class 4 vs. 1(adjusted OR= 4.28(95%CI 1.82,10.1).
Conclusion
Age 80 years or older, medical comorbidities, dependent functional status, and unintentional weight loss are associated with increased major postoperative complications after gynecologic procedures.