Anesthesia management and outcomes of gynecologic oncology surgery

ABSTRACT

Objectives

This study assessed postoperative mortality, morbidity, and complications associated with anesthesia administration for gynecologic oncology abdominal surgery and investigated the risk factors for the development of these complications

Methods

We conducted a retrospective cohort study analyzing the data of patients who underwent elective gynecologic oncology surgery between 2010 and 2017. The demographic data; comorbidities; preoperative anemia; Charlson Comorbidity Index; anesthesia management; complications; preoperative, intraoperative, and postoperative periods; mortality; and morbidity were investigated. The patients were classified as surviving or deceased. Subgroup analyses of patients with endometrial, ovarian, cervical, and other cancers were performed.

Results

We analyzed 416 patients; 325 survived and 91 were deceased. The postoperative chemotherapy rates (p < 0.001), and postoperative blood transfusion rates (p = 0.010) were significantly higher in the deceased group, while the preoperative albumin levels were significantly lower in the deceased group (p < 0.001). Infused colloid amount was higher in the deceased group of endometrial (p = 0.018) and ovarian cancers (p = 0.017).

Conclusions

Perioperative patient management for cancer surgery requires a multidisciplinary approach led by an anesthesiologist and surgeon. Any improvement in the duration of hospital stay, morbidity, or recovery rate depends on the success of the multidisciplinary team.

Plain Language Summary

Cancer surgeries in the female reproductive system can sometimes cause severe complications, including death. Proper anesthesia management is crucial to reducing such negative outcomes. This study looked at patient records to understand the factors that led to bad results with anesthesia. Researchers focused on both pre-surgery preparations and post-surgery care. They found that factors like needing a blood transfusion, wound infections, getting chemotherapy after surgery, and low blood albumin levels increased the death rate. Strict monitoring of fluid balance and blood circulation during surgery improved survival chances. The work begins long before the operating theater. Anesthesiologists should carefully assess patients before surgery, and teamwork between the anesthesiologist and surgeon is vital throughout treatment. Identifying risks, taking precautions, and minimizing high-risk interventions can decrease the days passed at the hospital, improve recovery, and reduce deaths from surgery complications.

KEYWORDS:

• Gynecology
• oncology
• anesthesia
• mortality
• morbidity
• complication

Abbreviations

AICU	=	Anesthesia intensive care unit
ASA	=	American Society of Anesthesiologists
ERAS	=	Enhanced Recovery after Surgery
IFA	=	International Fluid Academy
LA	=	Local anesthetic
NK	=	Natural killer
PACU	=	Post-anesthesia care unit
PCA	=	Patient-controlled analgesia
SSI	=	Surgical site infection
TAP	=	Transversus abdominis plane
TEA	=	Thoracic epidural analgesia
VAS	=	Visual analogue scale

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Hicret Yeniay: conducted the study and wrote the manuscript as the first author; Bahar Kuvaki: supervisor and critical contributions; Sule Ozbilgin: conducted the study and wrote the manuscript as the corresponding author; Hasan Bahadır Saatli: conducted the study and collected the data; Hikmet Tunç Timur: conducted the study, data collection, and statistical analysis.

Additional information

Funding

The authors did not receive funding for this research.