Introduction/Background The management of surgical complications in Gynecology oncology is crucial due to its frequency. Our objective is to identify independent factors related to surgical complications and implement an internal audit system.

Methodology Since May ’21 to October ’23, all surgical complications were collected in a specific prospective database and classified according Clavien-Dindo. Monthly morbi/mortality session was held to audit internally all complications. Basal characteristics, surgical records and postoperative data were analyzed. Odd ratios (OR) are reported with 95% confidence intervals (95%CI). Since March 2023, an award was presented monthly to the top recruiter of complications, named MVG (most valuable gynecologist.). External audit was done in this period.

Results A total of 137 events from 113 patients were evaluated and classified in 36 different complications. 77.4% of complications were caused by surgery. 35% were managed as outpatient, 37.2% inpatient and 24.8% during admission.

75.2% were Clavien-Dindo I-II, 21.9% Clavien-Dindo III-IV, 2.9% were Clavien-Dindo V. Median time for symptoms of Clavien-Dindo I-II was 10 days vs 6 days Clavien-Dindo III-V. Surgical approaches: 39.4% robotics, 47.4% laparotomy. 93.4% didn’t have previous intra-operative complications.

Mean complications per month was 20% (137/674), top 3 complications were vault hematoma 17.5%, Urinary infection 12.4%, Abdominal dehiscence 11.7%.

In multivariate analysis, independent risk factor for patients with Clavien-Dindo III-V complications was high Aletti score 5.344 (0.873–32.7), p=0.07 and All patients ECOG ≥2 had Clavien-Dindo ≥3 (p=0.001).

After MVG implementation, complications per month were 4.2 before MVG vs 6.1 after MVG. An external audit observed a decrease in risk-adjusted complications index since 2021.

Conclusion Independent risk factor for Clavien-Dindo III-V was high Aletti score. ECOG ≥2 patients had high risk of complications. The introduction of a motivational reward system can lead to an increase in the reporting of complications. Internal and external audits can contribute to the reduction of complications.

Disclosures No.