title: Predictors of complications in gynaecological oncological surgery: a prospective multicentre study (UKGOSOC-UK gynaecological oncology surgical outcomes and complications).
abstract: BACKGROUND
  There are limited data on surgical outcomes in gynaecological oncology. We report on predictors of complications in a multicentre prospective study.
  
  
  METHODS
  Data on surgical procedures and resulting complications were contemporaneously recorded on consented patients in 10 participating UK gynaecological cancer centres. Patients were sent follow-up letters to capture any further complications. Post-operative (Post-op) complications were graded (I-V) in increasing severity using the Clavien-Dindo system. Grade I complications were excluded from the analysis. Univariable and multivariable regression was used to identify predictors of complications using all surgery for intra-operative (Intra-op) and only those with both hospital and patient-reported data for Post-op complications.
  
  
  RESULTS
  Prospective data were available on 2948 major operations undertaken between April 2010 and February 2012. Median age was 62 years, with 35% obese and 20.4% ASA grade ⩾3. Consultant gynaecological oncologists performed 74.3% of operations. Intra-op complications were reported in 139 of 2948 and Grade II-V Post-op complications in 379 of 1462 surgeries. The predictors of risk were different for Intra-op and Post-op complications. For Intra-op complications, previous abdominal surgery, metabolic/endocrine disorders (excluding diabetes), surgical complexity and final diagnosis were significant in univariable and multivariable regression (P<0.05), with diabetes only in multivariable regression (P=0.006). For Post-op complications, age, comorbidity status, diabetes, surgical approach, duration of surgery, and final diagnosis were significant in both univariable and multivariable regression (P<0.05).
  
  
  CONCLUSIONS
  This multicentre prospective audit benchmarks the considerable morbidity associated with gynaecological oncology surgery. There are significant patient and surgical factors that influence this risk.
authors.affiliation: Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK.
authors.forename: R
authors.initials: R
authors.lastname: Iyer
authors.affiliation: Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK.
authors.forename: A
authors.initials: A
authors.lastname: Gentry-Maharaj
authors.affiliation: National Cancer Intelligence Network Gynaecology Clinical Reference Group, 5th Floor, Wellington House, 133-155 Waterloo Road, London SE1 8UG, UK.
authors.forename: A
authors.initials: A
authors.lastname: Nordin
authors.affiliation: Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK.
authors.forename: M
authors.initials: M
authors.lastname: Burnell
authors.affiliation: Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK.
authors.forename: R
authors.initials: R
authors.lastname: Liston
authors.affiliation: Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK.
authors.forename: R
authors.initials: R
authors.lastname: Manchanda
authors.affiliation: Department of Gynaecological Cancer, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall TR1 3LJ, UK.
authors.forename: N
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authors.affiliation: Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK.
authors.forename: R
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authors.affiliation: Department of Gynaecological Oncology, Cheltenham General Hospital, Sandford Road, Cheltenham, Gloucestershire GL53 7AN, UK.
authors.forename: R
authors.initials: R
authors.lastname: Gornall
authors.affiliation: Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK.
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authors.affiliation: Pan Birmingham Gynaecological Cancer Centre, Birmingham City Hospital, Dudley Road, Birmingham, West Midlands B18 7QH, UK.
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authors.affiliation: Department of Gynaecological Oncology, Cheltenham General Hospital, Sandford Road, Cheltenham, Gloucestershire GL53 7AN, UK.
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authors.forename: S
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authors.affiliation: Department of Gynaecological Oncology, The Ipswich Hospital NHS Trust, Heath Road, Ipswich, Suffolk IP4 5PD, UK.
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authors.lastname: Linder
authors.affiliation: Department of Gynaecological Cancer, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall TR1 3LJ, UK.
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authors.affiliation: Trent Cancer Registry, 5 Old Fulwood Road, Sheffield S10 3TG, UK.
authors.forename: D
authors.initials: D
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authors.affiliation: Department of Gynaecological Oncology, University College London Hospital NHS Foundation Trust, 2nd Floor North, 250 Euston Road, London NW1 2PG, UK.
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authors.initials: T
authors.lastname: Mould
authors.affiliation: Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK.
authors.forename: S
authors.initials: S
authors.lastname: Varkey
authors.affiliation: Department of Gynaecological Oncology, University College London Hospital NHS Foundation Trust, 2nd Floor North, 250 Euston Road, London NW1 2PG, UK.
authors.forename: A
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authors.affiliation: Department of Gynaecological Oncology, The Ipswich Hospital NHS Trust, Heath Road, Ipswich, Suffolk IP4 5PD, UK.
authors.forename: B
authors.initials: B
authors.lastname: Rufford
authors.affiliation: Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK.
authors.forename: A
authors.initials: A
authors.lastname: Ryan
authors.affiliation: Department of Gynaecological Oncology, Glasgow Royal Infirmary, 16 Alexandra Parade, Glasgow G31 2ER, UK.
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authors.lastname: Shanbhag
authors.affiliation: Trent Cancer Registry, 5 Old Fulwood Road, Sheffield S10 3TG, UK.
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authors.affiliation: Gynaecological Cancer Research Centre, Department of Women's Cancer, Institute for Women's Health, University College London, 1st Floor Maple House, 149 Tottenham Court Road, London W1T 7DN, UK.
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mesh_terms: D000368:Aged; D054869:Clinical Audit; D005260:Female; D005833:Genital Neoplasms, Female / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000706:statistics & numerical data; D008197:Lymph Node Excision / Q000009:adverse effects / Q000706:statistics & numerical data; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology