title: Preoperative quality of life and surgical outcomes in gynecologic oncology patients: a new predictor of operative risk?
abstract: OBJECTIVE
  Quality of life (QoL) for women with gynecologic malignancies is predictive of chemotherapy related toxicity and overall survival but has not been studied in relation to surgical outcomes and hospital readmissions. Our goal was to evaluate the association between baseline, pre-operative QoL measures and 30-day post-operative morbidity and health resource utilization by gynecologic oncology patients.
  
  
  METHODS
  We analyzed prospectively collected survey data from an institution-wide cohort study. Patients were enrolled from 8/2012 to 6/2013 and medical record data was abstracted (demographics, comorbid conditions, and operative outcomes). Responses from several validated health-related QoL instruments were collected. Bivariate tests and multivariable linear and logistic regression models were used to evaluate factors associated with QoL scores.
  
  
  RESULTS
  Of 182 women with suspected gynecologic malignancies, 152 (84%) were surveyed pre-operatively and 148 (81%) underwent surgery. Uterine (94; 63.5%), ovarian (26; 17.5%), cervical (15; 10%), vulvar/vaginal (8; 5.4%), and other (5; 3.4%) cancers were represented. There were 37 (25%) cases of postoperative morbidity (PM), 18 (12%) unplanned ER visits, 9(6%) unplanned clinic visits, and 17 (11.5%) hospital readmissions (HR) within 30days of surgery. On adjusted analysis, lower functional well-being scores resulted in increased odds of PM (OR 1.07, 95%CI 1.01-.1.21) and HR (OR 1.11, 95%CI 1.03-1.19). A subjective global assessment score was also strongly associated with HR (OR 1.89, 95%CI 1.14, 3.16).
  
  
  CONCLUSIONS
  Lower pre-operative QoL scores are significantly associated with post-operative morbidity and hospital readmission in gynecologic cancer patients. This relationship may be a novel indicator of operative risk.
authors.affiliation: Division of Gynecologic Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Cancer Care Quality Training Program, Division of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA. Electronic address: kmdoll@med.unc.edu.
authors.forename: K M
authors.initials: KM
authors.lastname: Doll
authors.affiliation: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: A C
authors.initials: AC
authors.lastname: Snavely
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
authors.forename: A
authors.initials: A
authors.lastname: Kalinowski
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: D E
authors.initials: DE
authors.lastname: Irwin
authors.affiliation: Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: J T
authors.initials: JT
authors.lastname: Bensen
authors.affiliation: Division of Gynecologic Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: V
authors.initials: V
authors.lastname: Bae-Jump
authors.affiliation: Division of Gynecologic Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: J F
authors.initials: JF
authors.lastname: Boggess
authors.affiliation: Division of Gynecologic Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: J T
authors.initials: JT
authors.lastname: Soper
authors.affiliation: Division of Gynecologic Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: W R
authors.initials: WR
authors.lastname: Brewster
authors.affiliation: Division of Gynecologic Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: P A
authors.initials: PA
authors.lastname: Gehrig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D057234:Preoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Postoperative recovery; Quality of life; Surgical complications
references.citation: Gynecol Oncol. 2012 Mar;124(3):379-82
references.pmid: 22119995
references.citation: Ann Surg. 2003 Nov;238(5):690-6
references.pmid: 14578731
references.citation: Lancet Oncol. 2009 Sep;10(9):865-71
references.pmid: 19695956
references.citation: Ann Surg. 2006 May;243(5):636-41; discussion 641-4
references.pmid: 16632998
references.citation: J Surg Oncol. 2013 Sep;108(3):182-6
references.pmid: 23804149
references.citation: Ann Surg. 2015 Feb;261(2):345-52
references.pmid: 24651133
references.citation: J Clin Oncol. 2005 Aug 20;23(24):5605-12
references.pmid: 16110020
references.citation: J Am Coll Surg. 2013 May;216(5):976-85
references.pmid: 23522786
references.citation: Am J Obstet Gynecol. 2008 Oct;199(4):360.e1-9
references.pmid: 18928974
references.citation: J Clin Oncol. 2007 Feb 1;25(4):437-43
references.pmid: 17264340
references.citation: N Engl J Med. 2009 Apr 2;360(14):1418-28
references.pmid: 19339721
references.citation: Nutrition. 1996 Jan;12(1 Suppl):S15-9
references.pmid: 8850213
references.citation: J Clin Oncol. 2001 Mar 15;19(6):1809-17
references.pmid: 11251013
references.citation: Am J Clin Oncol. 1982 Dec;5(6):649-55
references.pmid: 7165009
references.citation: Qual Life Res. 2009 Sep;18(7):873-80
references.pmid: 19543809
references.citation: J Am Coll Surg. 2013 Oct;217(4):665-670.e1
references.pmid: 24054409
references.citation: Obstet Gynecol. 2012 Oct;120(4):871-81
references.pmid: 22996105
references.citation: Gynecol Oncol. 2011 Dec;123(3):467-73
references.pmid: 21958535
references.citation: Ann Surg. 2011 Jun;253(6):1223-9
references.pmid: 21412145
references.citation: Arch Gynecol Obstet. 2012 Jan;285(1):183-93
references.pmid: 21909752
references.citation: Ann Surg Oncol. 2013 Oct;20(11):3519-26
references.pmid: 23748607
references.citation: Gynecol Oncol. 2011 Sep;122(3):479-83
references.pmid: 21664659
references.citation: Gynecol Oncol. 2013 Sep;130(3):407-10
references.pmid: 23747329
references.citation: Gynecol Oncol. 2012 Oct;127(1):11-7
references.pmid: 22735788
references.citation: J Vasc Surg. 2011 Apr;53(4):912-7
references.pmid: 21215580
references.citation: J Clin Oncol. 1993 Mar;11(3):570-9
references.pmid: 8445433
references.citation: Int J Gynecol Cancer. 2004 Sep-Oct;14(5):875-81
references.pmid: 15361198