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Original research
Enhanced recovery for obese patients undergoing gynecologic cancer surgery
  1. Ross Harrison1,
  2. Maria D Iniesta1,
  3. Brandelyn Pitcher2,
  4. Pedro T Ramirez1,
  5. Katherine Cain3,
  6. Ashley M Siverand1,
  7. Gabriel Mena4,
  8. Javier Lasala4 and
  9. Larissa A Meyer1
  1. 1Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  2. 2Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  3. 3Clinical Pharmacy Services, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  4. 4Anesthesiology and Perioperative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to Dr Ross Harrison, Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA; ross.f.harrison{at}gmail.com

Abstract

Objective To compare post-operative length of stay and complication rates of matched obese and non-obese patients in an enhanced recovery (ERAS) program after open gynecologic cancer surgery.

Methods We performed an observational cohort study of patients (n=1225) undergoing open surgery from November 2014 to November 2018 at a tertiary cancer center. Patients undergoing multidisciplinary procedures, non-oncologic surgery, or procedures in addition to abdominal surgery were excluded (n=190). Obese and non-obese patients were matched by date, age, disease status, and surgical complexity. The primary outcome was post-operative length of stay. Secondary outcomes included 30-day peri-operative complications, re-operation, re-admission, opioid use, and program compliance.

Results After matching, 696 patients (348 obese, 348 non-obese) with median age of 57 years (IQR 48–66) were analyzed. Obese patients had a longer median procedure time (218 min vs 192.5 min, p<0.001) and greater median estimated blood loss (300 mL vs 200 mL, p<0.001). Median (IQR) post-operative length of stay was the same for obese and non-obese patients: 3 days (IQR 2–4). Obese and non-obese patients had similar rates of grade III–IV complications (10.9% and 6.6%, respectively, p=0.06), re-operation (2.3% and 1.4%, respectively, p=0.58), and re-admission (11.8% and 8.0%, respectively, p=0.13). Grade I–II complications were more common among obese patients (62.4% vs 48.3%, p<0.001) because they had more wound complications (17.8% vs 4.9%, p<0.001). Obese patients received more opioids both during surgery (morphine equivalent dose 57.25 mg (IQR 35–72.5) vs 50 mg (IQR 25–622.5), p=0.003) and after surgery (morphine equivalent daily dose 45 mg/day (IQR 10–96.2) vs 29.37 mg/day (IQR 7.5–70), p=0.01). Obese and non-obese patients had similar ERAS program compliance (70.1% and 69.8%, respectively, p=0.32).

Conclusions Neither post-operative length of stay nor the rate of serious complications differed significantly despite longer surgeries, greater blood loss, and more opioid use among obese patients. An ERAS program was safe, effective, and feasible for obese patients with suspected gynecologic cancer.

  • postoperative complications
  • surgery
  • postoperative care
  • obesity
  • morbid
  • gynecology

https://doi.org/10.1136/ijgc-2020-001663

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    Footnotes

    • Twitter @rossfh, @pedroramirezMD, @gabemenaMD, @LarissaAMeyerMD

    • Presented at This study was presented in part by LAM as a poster presentation at the 2019 International Gynecologic Cancer Society Meeting, September 19-22, 2019 in Rio de Janeiro, Brazil.

    • Contributors All authors have provided substantial contribution and are in agreement with all aspects of the final manuscript.

    • Funding This research was supported in part by grant 5T32CA101642 from the National Cancer Institute (supports the training of RH; PI, Dr Karen H. Lu); National Cancer Institute Cancer Center Support grant CA016672 (supports the MD Anderson Cancer Center Biostatistics Resource Group, of which BP is a member); and National Cancer Institute grant K07CA201013 (LAM). No commercial organization provided support, financial or otherwise, for this investigation.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. Deindentified participant data may be available for research collaboration. Decisions about data sharing are made on a case-by-case basis and are contingent upon relevant institutional and regulatory approvals.