A 5-Year Review of Gynaecological Oncology Patients Managed by a Fast Track Surgery Program

Abstract

Introduction: The aim of this study is to provide a comprehensive 5-year audit of patients undergoing laparotomy for suspected or confirmed gynaecological malignancy to document the frequency and incidence of adverse events and to investigate factors associated with shorter length of stay and readmission to hospital. Methods: A 5-year surgical audit of the period commencing 2008 and concluding 2012. All patients undergoing laparotomy were included in the audit without exclusions. Approval was granted by the local Ethics Review Committee. Results: Four hundred and twenty-seven patients underwent laparotomy for suspected or confirmed gynaecological malignancy and were managed by Fast Track Surgery (FTS) principles. Average age was 54.8 years and average weight and BMI were 73.4 kg and 28.1 respectively. Ultimately 254 (59%) patients had confirmed malignancy. Average surgery duration was 2.36 hours and average estimated blood loss (EBL) at surgery was 262 mL. Median and mean LOS was 3.0 and 3.5 days respectively with 125 (29%) patients discharged on day 2. Overall transfusion rate was 5%. Other adverse events in decreasing frequency were hospital readmission (3.7%), significant wound infection (3%) and unplanned High Dependency Unit (HDU) admission (1.4%). All other adverse events were uncommon with rates <0.5%. Factors associated with a short LOS included year of surgery, age, performance status, malignant vs benign pathology, the use of COX-2 inhibitors, operation time, incision type, transfusion, and radical hysterectomy, at least 1 complication, if patients tolerated early oral feeding (EOF). In multivariable analysis, year, age, performance status, the use of COX-2 inhibitors, operation time and incision type were significant. Factors associated with readmission included the use of COX-2 inhibitors, operation time, performance of a lymph node dissection, return to operating theatre, operation category at least 1 complication, and in multivariable analysis lymph node dissection and the occurrence of at least 1 complication were significant. Conclusions: This 5-year audit is important in establishing a contemporary incidence and the prevalence rate of serious adverse events for patients with suspected or confirmed gynaecological cancer undergoing laparotomy and managed by FTS principles. The community can be reassured that the incidence of serious adverse events is low when managed by FTS principles.

Prospective study of patient satisfaction with enhanced recovery after surgery (ERAS) protocol in the immediate post‐operative period in gynaecological oncology

“…It has already been demonstrated that ERAS protocols are safe and effective pathways in the management of patients with gynaecological malignancy 2–4,9–11 . However, the findings of this study also report that most patients find it not just an acceptable option but highly satisfying, corroborating the findings of similar studies 7,8 …”

“…The gynaecological oncology department in our unit has successfully adopted the ERAS pathway for over ten years, enabling a shorter length of stay with comparable complication and readmission rates to the standard post‐operative protocol 2–4 . While there is evidence that ERAS pathways are associated with comparable patient satisfaction to conventional pathways in other fields in surgery, 5,6 such data are still lacking in the field of gynaecological oncology due to low power and recruitment rates in the existing literature 7,8 .…”

Physical Activity Correlates, Barriers, and Preferences for Women With Gynecological Cancer

“…To give some indication of the generalizability of our results, we compared the characteristics of women who participated in this study to gynecological oncology patients included in a recent 5-year audit of the gynecological cancer clinic at Royal Prince Alfred Hospital, Sydney. 47 We found that they had a fairly similar mean age (57.5 vs 54.8 years, respectively) and mean BMI (27.1 vs 28.1 kg/m 2 , respectively). Both hospitals in this study were located in inner-city Sydney.…”