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Evaluating determinants of prolonged hospitalization following minimally invasive surgery for endometrial cancer
Abstracts / Gynecologic Oncology 141 (2016) 2–208
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undergoing elective minimally invasive hysterectomy (CPT codes 58500–58599) for endometrial cancer. Length of stay was defined as normal for 0 to 1 days and prolonged for discharge 2 or more days after surgery. Pre- and intraoperative factors were compared using a χ2 test of independence with a nominal value of P b .05 as a threshold for significance. Results: We identified 6,150 patients who underwent minimally invasive hysterectomy for endometrial cancer. Of those, 4,698 patients (76.4%) were discharged home by the first postoperative day. NSQIPtracked postoperative complications were 3 times more common among women staying in the hospital longer than 1 day versus those discharged on time (relative risk [RR] 3.65, 95% CI 3.00–4.34). Factors associated with prolonged hospitalization included: not-independent functional status (RR 4.4, 95% CI 2.86–6.78), age over 70 years (RR 2.03, 95% CI 1.79–2.31), dyspnea before surgery (RR 1.72, 95% CI 1.38– 2.15), diabetes (RR 1.55, 95% CI 1.35–1.78), hypertension (RR 1.54, 95% CI 1.36–1.74), class III obesity (RR 1.17, 95% CI 1.03–1.34). Surgery longer than 4 hours was also associated with an almost 3-fold increase in risk of prolonged hospitalization (RR 2.97, 95% CI 2.59–3.41), and lymph node dissection (CPT 58548) increased the risk of prolonged hospitalization by 34% (RR 1.34, 95% CI 1.22–1.49). Conclusions: Some preoperative comorbidities, long surgical duration, and lymph node dissection are significant risk factors for prolonged hospitalization after minimally invasive surgery. Although class III obesity cannot be significantly altered in the weeks before surgery, improving poor functional status with prehabilitation may reduce the complications and costs associated with treating endometrial cancer.
DP
Georgia, and from the Alabama Statewide Cancer Registry. Questions were adapted from Cancer Care Outcomes Research and Surveillance Consortium’s questionnaire. We asked women about the specialty of the physicians they saw, knowledge about GO care, and confidence in their physicians. Results: Overall, 95% had seen 1 or more GO: 91% for surgery, 79% for decisions about treatment, 63% for diagnosis, and 59% for chemotherapy. Fewer (81%) reported that they had seen 1 or more GO. Women not reporting seeing GOs were more likely to be African American (36% vs 21% of those reporting GO care) , to have high school education or less (58% vs 36%), to be within 6 months of diagnosis (30% vs 17%), and to have stage III disease (36% vs 29%). Results on knowledge and confidence are in Table 1. Most important differences in knowledge were: 19% of women not reporting GO care vs 6% women reporting GO care strongly agreed/agreed that there are no clear benefits to receiving GO care; 72% women not reporting GO care versus 82% of women reporting GO care strongly agreed/ agreed that GOs follow women from diagnosis to end of life, and 91% of women not reporting GO care versus 97% of women reporting GO care strongly agreed/agreed that some women clearly benefitted from receiving treatments from GOs. Most important differences in confidence were: 73% of women not reporting GOs versus 87% of women reporting GOs thought it was very likely or likely that their physicians will cure OC. Conclusions: One in five OC cases was not aware of the specialty of the physicians. These women were less likely to be aware of the advantages of receiving GO care or to have confidence in their physicians.
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164
Table 1 Knowledge about GOs and beliefs about doctors.
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doi:10.1016/j.ygyno.2016.04.427
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RR
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396 – Poster Preoperative hyponatremia in women with ovarian cancer: An additional cause for concern? J.Y. Martin, B.A. Goff, R.R. Urban. University of Washington Medical Center, Seattle, WA, USA
UN
doi:10.1016/j.ygyno.2016.04.426
395 – Poster Evaluating determinants of prolonged hospitalization following minimally invasive surgery for endometrial cancer J.B. Szender, P.C. Mayor, E. Zsiros, K. Moysich, S.B. Lele, K.O. Odunsi. Roswell Park Cancer Institute, Buffalo, NY, USA Objectives: To use a centralized multi-institutional dataset to determine the pre- and intraoperative factors associated with prolonged hospitalization after minimally invasive surgery for endometrial cancer. Methods: We inspected the National Surgical Quality Improvement Program (NSQIP) participant use files from 2007 to 2013 for patients
Objectives: An association between preoperative hyponatremia and postoperative 30-day morbidity and mortality has been reported. To date, no studies have assessed the association between hyponatremia and postoperative complications among women with gynecological cancer. Our objective was to determine if preoperative hyponatremia in women with ovarian, fallopian tube (FT), and primary peritoneal cancers (PPC) is associated with postoperative mortality and complications. Methods: We performed a retrospective population-based cohort study of women with a postoperative diagnosis of ovarian, FT, or PPC who had a cytoreductive procedure in the National Surgical Quality Improvement Program (NSQIP) database from 2005 to 2013. Women with a missing preoperative serum sodium measurement (n = 354) or hypernatremia (n = 350) were excluded. The primary exposure, preoperative sodium, was classified as normal (135–142 mEq/L) or hyponatremic (≤134 mEq/L). Where appropriate, categorical preoperative characteristics were compared using the χ2 and Fisher exact tests. Estimates of risk for 30-day postoperative mortality and complications were determined with logistic regression. Results: A total of 4,009 subjects met inclusion criteria. Subjects had similar body mass index (P = .21), functional status (P = .07), and comparable operative times (P = .31). Those with preoperative hyponatremia (n = 365) were older (P b .001) and more likely to have disseminated cancer (P b .001), ascites (P b .001), and chronic hypertension (P b .001) than women with normal serum sodium. Thirty-day mortality was higher in the hyponatremic group than in the normal serum sodium group (3.56% vs 1.18%). After adjusting for
OF
undergoing elective minimally invasive hysterectomy (CPT codes 58500–58599) for endometrial cancer. Length of stay was defined as normal for 0 to 1 days and prolonged for discharge 2 or more days after surgery. Pre- and intraoperative factors were compared using a χ2 test of independence with a nominal value of P b .05 as a threshold for significance. Results: We identified 6,150 patients who underwent minimally invasive hysterectomy for endometrial cancer. Of those, 4,698 patients (76.4%) were discharged home by the first postoperative day. NSQIPtracked postoperative complications were 3 times more common among women staying in the hospital longer than 1 day versus those discharged on time (relative risk [RR] 3.65, 95% CI 3.00–4.34). Factors associated with prolonged hospitalization included: not-independent functional status (RR 4.4, 95% CI 2.86–6.78), age over 70 years (RR 2.03, 95% CI 1.79–2.31), dyspnea before surgery (RR 1.72, 95% CI 1.38– 2.15), diabetes (RR 1.55, 95% CI 1.35–1.78), hypertension (RR 1.54, 95% CI 1.36–1.74), class III obesity (RR 1.17, 95% CI 1.03–1.34). Surgery longer than 4 hours was also associated with an almost 3-fold increase in risk of prolonged hospitalization (RR 2.97, 95% CI 2.59–3.41), and lymph node dissection (CPT 58548) increased the risk of prolonged hospitalization by 34% (RR 1.34, 95% CI 1.22–1.49). Conclusions: Some preoperative comorbidities, long surgical duration, and lymph node dissection are significant risk factors for prolonged hospitalization after minimally invasive surgery. Although class III obesity cannot be significantly altered in the weeks before surgery, improving poor functional status with prehabilitation may reduce the complications and costs associated with treating endometrial cancer.
DP
Georgia, and from the Alabama Statewide Cancer Registry. Questions were adapted from Cancer Care Outcomes Research and Surveillance Consortium’s questionnaire. We asked women about the specialty of the physicians they saw, knowledge about GO care, and confidence in their physicians. Results: Overall, 95% had seen 1 or more GO: 91% for surgery, 79% for decisions about treatment, 63% for diagnosis, and 59% for chemotherapy. Fewer (81%) reported that they had seen 1 or more GO. Women not reporting seeing GOs were more likely to be African American (36% vs 21% of those reporting GO care) , to have high school education or less (58% vs 36%), to be within 6 months of diagnosis (30% vs 17%), and to have stage III disease (36% vs 29%). Results on knowledge and confidence are in Table 1. Most important differences in knowledge were: 19% of women not reporting GO care vs 6% women reporting GO care strongly agreed/agreed that there are no clear benefits to receiving GO care; 72% women not reporting GO care versus 82% of women reporting GO care strongly agreed/ agreed that GOs follow women from diagnosis to end of life, and 91% of women not reporting GO care versus 97% of women reporting GO care strongly agreed/agreed that some women clearly benefitted from receiving treatments from GOs. Most important differences in confidence were: 73% of women not reporting GOs versus 87% of women reporting GOs thought it was very likely or likely that their physicians will cure OC. Conclusions: One in five OC cases was not aware of the specialty of the physicians. These women were less likely to be aware of the advantages of receiving GO care or to have confidence in their physicians.
RO
164
Table 1 Knowledge about GOs and beliefs about doctors.
TE
doi:10.1016/j.ygyno.2016.04.427
CO
RR
EC
396 – Poster Preoperative hyponatremia in women with ovarian cancer: An additional cause for concern? J.Y. Martin, B.A. Goff, R.R. Urban. University of Washington Medical Center, Seattle, WA, USA
UN
doi:10.1016/j.ygyno.2016.04.426
395 – Poster Evaluating determinants of prolonged hospitalization following minimally invasive surgery for endometrial cancer J.B. Szender, P.C. Mayor, E. Zsiros, K. Moysich, S.B. Lele, K.O. Odunsi. Roswell Park Cancer Institute, Buffalo, NY, USA Objectives: To use a centralized multi-institutional dataset to determine the pre- and intraoperative factors associated with prolonged hospitalization after minimally invasive surgery for endometrial cancer. Methods: We inspected the National Surgical Quality Improvement Program (NSQIP) participant use files from 2007 to 2013 for patients
Objectives: An association between preoperative hyponatremia and postoperative 30-day morbidity and mortality has been reported. To date, no studies have assessed the association between hyponatremia and postoperative complications among women with gynecological cancer. Our objective was to determine if preoperative hyponatremia in women with ovarian, fallopian tube (FT), and primary peritoneal cancers (PPC) is associated with postoperative mortality and complications. Methods: We performed a retrospective population-based cohort study of women with a postoperative diagnosis of ovarian, FT, or PPC who had a cytoreductive procedure in the National Surgical Quality Improvement Program (NSQIP) database from 2005 to 2013. Women with a missing preoperative serum sodium measurement (n = 354) or hypernatremia (n = 350) were excluded. The primary exposure, preoperative sodium, was classified as normal (135–142 mEq/L) or hyponatremic (≤134 mEq/L). Where appropriate, categorical preoperative characteristics were compared using the χ2 and Fisher exact tests. Estimates of risk for 30-day postoperative mortality and complications were determined with logistic regression. Results: A total of 4,009 subjects met inclusion criteria. Subjects had similar body mass index (P = .21), functional status (P = .07), and comparable operative times (P = .31). Those with preoperative hyponatremia (n = 365) were older (P b .001) and more likely to have disseminated cancer (P b .001), ascites (P b .001), and chronic hypertension (P b .001) than women with normal serum sodium. Thirty-day mortality was higher in the hyponatremic group than in the normal serum sodium group (3.56% vs 1.18%). After adjusting for