Share This Article:
Review Paper

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

Abstract Full-Text HTML Download Download as PDF (Size:139KB) PP. 36-41
DOI: 10.4236/ijcm.2014.51008    4,022 Downloads   5,262 Views   Citations

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.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

J. Carter, S. Philp and R. O’Connell, "A 5-Year Review of Gynaecological Oncology Patients Managed by a Fast Track Surgery Program," International Journal of Clinical Medicine, Vol. 5 No. 1, 2014, pp. 36-41. doi: 10.4236/ijcm.2014.51008.

References

[1] H. Kehlet, “Fast-Track Colorectal Surgery,” The Lancet, Vol. 371, No. 9615, 2008, pp. 791-793.
http://dx.doi.org/10.1016/S0140-6736(08)60357-8
[2] H. Kehlet, “Principles of Fast Track Surgery. Multimodal Perioperative Therapy Programme,” Der Chirurg, Vol. 80, No. 8, 2009, pp. 687-689.
http://dx.doi.org/10.1007/s00104-009-1675-2
[3] H. Kehlet and D. W. Wilmore, “Multimodal Strategies to Improve Surgical Outcome,” The American Journal of Surgery, Vol. 183, No. 6, 2002, pp. 630-641.
http://dx.doi.org/10.1016/S0002-9610(02)00866-8
[4] F. Carli, P. Charlebois, G. Baldini, O. Cachero and B. Stein, “An Integrated Multidisciplinary Approach to Implementation of a Fast-Track Program for Laparoscopic Colorectal Surgery,” Canadian Journal of Anaesthesia, Vol. 56, No. 11, 2009, pp. 837-842.
http://dx.doi.org/10.1007/s12630-009-9159-x
[5] K. Varadhan, D. N. Lobo and O. Ljungqvist, “Enhanced Recovery after Surgery: The Future of Improving Surgical Care,” Critical Care Clinics, Vol. 26, No. 3, 2010, pp. 527-547. http://dx.doi.org/10.1016/j.ccc.2010.04.003
[6] J. Carter, “Fast-Track Surgery in Gynaecology and Gynaecologic Oncology: A Review of a Rolling Clinical Audit,” ISRN Surgery, Vol. 2012, 2012, Article ID: 368014. http://dx.doi.org/10.5402/2012/368014
[7] J. Carter, R. Szabo, W. Sim, et al., “Fast Track Surgery in Gynaecological Oncology: A Clinical Audit,” Australian and New Zealand Journal of Obstetrics and Gynaecology, Vol. 50, No. 2, 2010, pp. 159-163.
http://dx.doi.org/10.1111/j.1479-828X.2009.01134.x
[8] “Clinical Indicator User Manual 2012: Gynaecology Version 6,” The Australian Council on Healthcare Standards, Ultimo, 2012, pp. 1-27.
[9] J. Carter and S. Philp, “Program Development and Extended Experience with a Fast Track Surgery Program,” Australian Society of Gynaecological Oncologists Annual Scientifc Meeting, Millbrook Resort, Queenstown, 2011.
[10] J. Carter and S. Philp, “Assessing Outcomes after Fast Track Surgical Management of Corpus Cancer,” Open Journal of Obstetrics and Gynecology, Vol. 1, No. 3, 2011, pp. 139-143.
http://dx.doi.org/10.4236/ojog.2011.13026
[11] J. Carter, S. Philp and V. Arora, “Fast Track Gynaecologic Surgery in the Overweight and Obese Patient,” International Journal of Clinical Medicine, Vol. 1, No. 2, 2010, pp. 64-69.
http://dx.doi.org/10.4236/ijcm.2010.12011
[12] J. Carter, S. Philp and V. Arora, “Early Discharge after Major Gynaecological Surgery: Advantages of Fast Track Surgery,” Open Journal of Obstetrics and Gynaecology, Vol. 1, No. 1, 2011, pp. 1-5.
http://dx.doi.org/10.4236/ojog.2011.11001
[13] J. Carter, S. Philp, V. Arora, et al., “Discharge on Postop Day 2 after Major Gynaecological Surgery. Is it Possible?” Oral Presentation 25th Annual Scientific Meeting Australian Society of Gynaecological Oncologists, Bunker Bay, 23-28 March 2010.
[14] RACS, “A Guide by the Royal Australian College of Surgeons. Surgical Audit and Peer Review,” Royal Australian College of Surgeons, Melbourne, 2008, p. 42.
[15] J. L. Walker, M. R. Piedmonte, N. M. Spirtos, et al., “Laparoscopy Compared With Laparotomy for Comprehensive Surgical Staging of Uterine Cancer: Gynecologic Oncology Group Study LAP2,” Journal of Clinical Oncology, Vol. 27, No. 32, 2009, pp. 5331-5336.
http://dx.doi.org/10.1200/JCO.2009.22.3248
[16] S. Kondalsamy-Chennakesavan, C. Bouman, S. De Jong, et al., “Clinical Audit in Gynecological Cancer Surgery: Development of a Risk Scoring System to Predict Adverse Events,” Gynecologic Oncology, Vol. 115, No. 3, 2009, pp. 329-333.
http://dx.doi.org/10.1016/j.ygyno.2009.08.004
[17] S. Bai, E. Huh, D. J. Jung, et al., “Urinary Tract Injuries during Pelvic Surgery: Incidence Rates and Predisposing Factors,” International Urogynecology Journal, Vol. 17, No. 4, 2006, pp. 360-364.
http://dx.doi.org/10.1007/s00192-005-0015-4
[18] B. Vakili, “The Incidence of Urinary Tract Injury during Hysterectomy: A Prospective Analysis Based on Universal Cystoscopy,” American Journal of Obstetrics & Gynecology, Vol. 192, No. 5, 2005, pp. 1599-1604.
http://dx.doi.org/10.1016/j.ajog.2004.11.016
[19] M. Wechter, M. Pearlman and K. Hartmann, “Reclosure of the Disrupted Laparotomy Wound: A Systematic Review,” Obstetrics & Gynecology, Vol. 106, No. 2, 2005, pp. 376-383.
http://dx.doi.org/10.1097/01.AOG.0000171114.75338.06
[20] E. A. Erekson, S. O. Yip, M. M. Ciarleglio and T. R. Fried, “Postoperative Complications after Gynecologic Surgery,” Obstetrics & Gynecology, Vol. 118, No. 4, 2011, pp. 785-793.
http://dx.doi.org/10.1097/AOG.0b013e31822dac5d
[21] The Australian Council on Healthcare Standards (ACHS), “Australian Clinical Indicator Report 2004-2011,” 13th Edition, The Australian Council on Healthcare Standards, Ultimo, 2012.
[22] A. Peedicayil, A. Weaver, X. Li, E. Carey, W. Cliby and A. Mariani, “Incidence and Timing of Venous Thromboembolism after Surgery for Gynecological Cancer,” Gynecologic Oncology, Vol. 121, No. 1, 2011, pp. 64-69.
http://dx.doi.org/10.1016/j.ygyno.2010.11.038

  
comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.