Factors Predictive of 90-Day Morbidity, Readmission, and Costs in Patients Undergoing Pelvic Exenteration

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Abstract

OBJECTIVE: Pelvic exenteration for recurrent gynecological malignancies is characterized by a high rate of severe complications. Factors predictive of morbidity, readmission, and cost were analyzed.

METHODS: Data of consecutive patients undergoing pelvic exenteration between January 2007 and December 2016 were prospectively evaluated.

RESULTS: Fifty-eight patients were included in the analysis. Anterior, posterior, and total exenterations were executed in 39 (67%), 9 (16%), and 10 (17%) patients, respectively. Ten (15.5%) severe complications occurred: 8 (20.5%), 0 (0%), and 1 (10%) after anterior, posterior, and total exenterations, respectively. Radiotherapy dosage, time between radiotherapy and surgery, and previous administration of chemotherapy did not influence 90-day complications and readmission. At multivariable analysis, albumin levels less than 3.5 g/dL (odds ratio, 16.2 [95% confidence interval, 2.85-92.8]; P = 0.002) and history of deep vein thrombosis (odds ratio, 9.6 [95% confidence interval, 0.93-98.2]; P = 0.057) were associated with 90-day morbidity. Low albumin levels independently correlated with readmission (P = 0.011). The occurrence of 90-day postoperative complications and readmission increased costs of a median of +12,500 and +6000 euros, respectively (P < 0.05).

CONCLUSIONS: Preoperative patient selection is a key point for the reduction of postoperative complications after pelvic exenteration. Further prospective studies are warranted to improve patient selection.

Original languageEnglish
Pages (from-to)975-982
Number of pages8
JournalInternational journal of gynecological cancer : official journal of the International Gynecological Cancer Society
Volume28
Issue number5
DOIs
Publication statusPublished - Jun 2018

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Pelvic Exenteration
Morbidity
Costs and Cost Analysis
Patient Selection
Radiotherapy Dosage
Albumins
Odds Ratio
Confidence Intervals
Venous Thrombosis
Radiotherapy
Prospective Studies
Drug Therapy
Neoplasms

Cite this

@article{e190fb09aa0c450480eb88e54b4af4ba,
title = "Factors Predictive of 90-Day Morbidity, Readmission, and Costs in Patients Undergoing Pelvic Exenteration",
abstract = "OBJECTIVE: Pelvic exenteration for recurrent gynecological malignancies is characterized by a high rate of severe complications. Factors predictive of morbidity, readmission, and cost were analyzed.METHODS: Data of consecutive patients undergoing pelvic exenteration between January 2007 and December 2016 were prospectively evaluated.RESULTS: Fifty-eight patients were included in the analysis. Anterior, posterior, and total exenterations were executed in 39 (67{\%}), 9 (16{\%}), and 10 (17{\%}) patients, respectively. Ten (15.5{\%}) severe complications occurred: 8 (20.5{\%}), 0 (0{\%}), and 1 (10{\%}) after anterior, posterior, and total exenterations, respectively. Radiotherapy dosage, time between radiotherapy and surgery, and previous administration of chemotherapy did not influence 90-day complications and readmission. At multivariable analysis, albumin levels less than 3.5 g/dL (odds ratio, 16.2 [95{\%} confidence interval, 2.85-92.8]; P = 0.002) and history of deep vein thrombosis (odds ratio, 9.6 [95{\%} confidence interval, 0.93-98.2]; P = 0.057) were associated with 90-day morbidity. Low albumin levels independently correlated with readmission (P = 0.011). The occurrence of 90-day postoperative complications and readmission increased costs of a median of +12,500 and +6000 euros, respectively (P < 0.05).CONCLUSIONS: Preoperative patient selection is a key point for the reduction of postoperative complications after pelvic exenteration. Further prospective studies are warranted to improve patient selection.",
author = "Giorgio Bogani and Mauro Signorelli and Antonino Ditto and Fabio Martinelli and Jvan Casarin and Lavinia Mosca and {Leone Roberti Maggiore}, Umberto and Valentina Chiappa and Domenica Lorusso and Francesco Raspagliesi",
year = "2018",
month = "6",
doi = "10.1097/IGC.0000000000001251",
language = "English",
volume = "28",
pages = "975--982",
journal = "International Journal of Gynecological Cancer",
issn = "1048-891X",
publisher = "Lippincott Williams and Wilkins",
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}

TY - JOUR

T1 - Factors Predictive of 90-Day Morbidity, Readmission, and Costs in Patients Undergoing Pelvic Exenteration

AU - Bogani, Giorgio

AU - Signorelli, Mauro

AU - Ditto, Antonino

AU - Martinelli, Fabio

AU - Casarin, Jvan

AU - Mosca, Lavinia

AU - Leone Roberti Maggiore, Umberto

AU - Chiappa, Valentina

AU - Lorusso, Domenica

AU - Raspagliesi, Francesco

PY - 2018/6

Y1 - 2018/6

N2 - OBJECTIVE: Pelvic exenteration for recurrent gynecological malignancies is characterized by a high rate of severe complications. Factors predictive of morbidity, readmission, and cost were analyzed.METHODS: Data of consecutive patients undergoing pelvic exenteration between January 2007 and December 2016 were prospectively evaluated.RESULTS: Fifty-eight patients were included in the analysis. Anterior, posterior, and total exenterations were executed in 39 (67%), 9 (16%), and 10 (17%) patients, respectively. Ten (15.5%) severe complications occurred: 8 (20.5%), 0 (0%), and 1 (10%) after anterior, posterior, and total exenterations, respectively. Radiotherapy dosage, time between radiotherapy and surgery, and previous administration of chemotherapy did not influence 90-day complications and readmission. At multivariable analysis, albumin levels less than 3.5 g/dL (odds ratio, 16.2 [95% confidence interval, 2.85-92.8]; P = 0.002) and history of deep vein thrombosis (odds ratio, 9.6 [95% confidence interval, 0.93-98.2]; P = 0.057) were associated with 90-day morbidity. Low albumin levels independently correlated with readmission (P = 0.011). The occurrence of 90-day postoperative complications and readmission increased costs of a median of +12,500 and +6000 euros, respectively (P < 0.05).CONCLUSIONS: Preoperative patient selection is a key point for the reduction of postoperative complications after pelvic exenteration. Further prospective studies are warranted to improve patient selection.

AB - OBJECTIVE: Pelvic exenteration for recurrent gynecological malignancies is characterized by a high rate of severe complications. Factors predictive of morbidity, readmission, and cost were analyzed.METHODS: Data of consecutive patients undergoing pelvic exenteration between January 2007 and December 2016 were prospectively evaluated.RESULTS: Fifty-eight patients were included in the analysis. Anterior, posterior, and total exenterations were executed in 39 (67%), 9 (16%), and 10 (17%) patients, respectively. Ten (15.5%) severe complications occurred: 8 (20.5%), 0 (0%), and 1 (10%) after anterior, posterior, and total exenterations, respectively. Radiotherapy dosage, time between radiotherapy and surgery, and previous administration of chemotherapy did not influence 90-day complications and readmission. At multivariable analysis, albumin levels less than 3.5 g/dL (odds ratio, 16.2 [95% confidence interval, 2.85-92.8]; P = 0.002) and history of deep vein thrombosis (odds ratio, 9.6 [95% confidence interval, 0.93-98.2]; P = 0.057) were associated with 90-day morbidity. Low albumin levels independently correlated with readmission (P = 0.011). The occurrence of 90-day postoperative complications and readmission increased costs of a median of +12,500 and +6000 euros, respectively (P < 0.05).CONCLUSIONS: Preoperative patient selection is a key point for the reduction of postoperative complications after pelvic exenteration. Further prospective studies are warranted to improve patient selection.

U2 - 10.1097/IGC.0000000000001251

DO - 10.1097/IGC.0000000000001251

M3 - Article

VL - 28

SP - 975

EP - 982

JO - International Journal of Gynecological Cancer

JF - International Journal of Gynecological Cancer

SN - 1048-891X

IS - 5

ER -