Background
There are currently no assessments of the impact of surgical complications on health-related
quality of life in gynecology and gynecologic oncology. This is despite complications
being a central focus of surgical outcome measurement, and an increasing awareness
of the need for patient-reported data when measuring surgical quality.
Objective
We sought to measure the impact of surgical complications on health-related quality
of life at 1 month postoperatively, in women undergoing gynecologic and gynecologic
oncology procedures.
Study Design
This is a prospective cohort study of women undergoing surgery by gynecologic oncologists
at a tertiary care academic center from October 2013 through October 2014. Patients
were enrolled preoperatively and interviewed at baseline and 1, 3, and 6 months postoperatively.
Health-related quality of life measures included validated general and disease-specific
instruments, measuring multiple aspects of health-related quality of life, including
anxiety and depression. The medical record was abstracted for clinical data and surgical
complications were graded using validated Clavien-Dindo criteria, and women grouped
into those with and without postoperative complications. Bivariate statistics, analysis
of covariance, responder analysis, and multivariate modeling was used to analyze the
relationship of postoperative complications to change health-related quality of life
from baseline to 1 month. Plots of mean scores and change over time were constructed.
Results
Of 281 women enrolled, response rates were 80% (n = 231/281) at baseline, and from
that cohort, 81% (n = 187/231), 74% (n = 170/231), and 75% (n = 174/231) at 1, 3,
and 6 months, respectively. The primary analytic cohort comprised 185 women with completed
baseline and 1-month interviews, and abstracted clinical data. Uterine (n = 84, 45%),
ovarian (n = 23, 12%), cervical (n = 17, 9%), vulvar (n = 3, 2%), and other (n = 4,
2%) cancers were represented, along with 53 (30%) cases of benign disease. There were
42 (24%) racial/ethnic minority women. Minimally invasive (n = 115, 63%) and laparotomy
(n = 60, 32%) procedures were performed. Postoperative complications occurred in 47
(26%) of patients who experienced grade 1 (n = 12), grade 2 (n = 29), and grade 3
(n = 6) complications. At 1 month, physical (20.6 vs 22.5, P = .04) and functional (15.4 vs 18.3, P = .02) well-being, global physical health (43.1 vs 46.3, P = .02), and work ability (3 vs 7.2, P = .001) were lower in postoperative complication vs non-postoperative complication
women. Relative change, however, in most health-related quality of life domains from
baseline to 1 month did not differ between postoperative complication and nonpostoperative
complication groups. Postoperative complication patients did have increased odds of
sustained or worsened anxiety at 1 month vs baseline (odds ratio, 2.5; 95% confidence
interval, 1.2–5.0) compared to nonpostoperative complication patients.
Conclusion
Collectively, women who experienced postoperative complications after gynecologic
and gynecologic oncology procedures did not appear to have differences in most health-related
quality of life trends over time compared to those who did not. An exception was anxiety,
where postoperative complications were associated with sustained or worsened levels
of high anxiety after surgery.
Key words
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Article info
Publication history
Published online: April 28, 2016
Accepted:
April 19,
2016
Received in revised form:
March 23,
2016
Received:
January 9,
2016
Footnotes
The research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health (NIH) under award R25CA116339 and the North Carolina University Cancer Research Fund. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
The authors report no conflict of interest.
Cite this article as: Doll KM, Barber EL, Bensen JT, et al. The impact of surgical complications on health-related quality of life in women undergoing gynecologic and gynecologic oncology procedures: a prospective longitudinal cohort study. Am J Obstet Gynecol 2016;215:457.e1-13.
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