RT Journal Article
SR Electronic
T1 #145 International variations in post-operative morbidity and mortality following gynaecological oncology surgery (GO SOAR1)
JF International Journal of Gynecologic Cancer
JO Int J Gynecol Cancer
FD BMJ Publishing Group Ltd
SP A410
OP A411
DO 10.1136/ijgc-2023-ESGO.871
VO 33
IS Suppl 3
A1 Gaba, Faiza
A1 Ash, Karen
A1 Blyuss, Oleg
A1 Bizzarri, Nicolò
A1 Kamfwa, Paul
A1 Saiz, Allison
A1 Paranjothy, Shantini
A1 Cibula, David
YR 2023
UL http://ijgc.bmj.com/content/33/Suppl_3/A410.2.abstract
AB Introduction/Background Gynaecological malignancies affect women in low and middle income countries (LMICs) at disproportionately higher rates compared with high income countries (HICs), but little is known about global variations in access, quality and outcomes in gynaecological cancer care. The aim if our study was to evaluate international variation in post-operative morbidity and mortality following gynaecological oncology surgery between LMIC and HIC settings.Methodology Multicentre, international prospective cohort-study of women undergoing surgery for primary ovary/uterus/cervix/vulva/vagina/gestational trophoblastic malignancies (NCT04579861). Multilevel logistic-regression determined relationships within three-level nested models of patients within hospitals/countries.Results We enrolled 1820 patients from 73 hospitals in 27 countries (1078 (59.2%) high income countries, 453 (24.9%) upper middle income countries, 174 (9.6%) lower middle income countries, 115 (6.3%) low income countries). Mean follow-up was 58.7 and 55.7 days from date of surgery in LMICs/HICs respectively. Overall-morbidity (Clavien-Dindo I-IV) for all tumour-groups was 34.7% (233/672) and 33.5% (338/1009), whilst mortality 2.1% (14/672) versus 1% (10/1009) for LMICs/HICs respectively. Minor-morbidity (Clavien-Dindo I-II) for all tumour-groups was 26.5% (178/672) and 26.5% (267/1009), whilst major-morbidity (Clavien-Dindo III-V) 8.2% (55/672) and 7% (71/1009) for LMICs/HICs respectively. Higher minor-morbidity was associated with previous laparoscopic surgery (OR=1.435, 95%CI=1.046–1.966, p=0.025), COVID-19 positive status (OR=5.025, 95%CI=1.262–20.008, p=0.022), pre-operative mechanical bowel preparation (OR=1.474, 95%CI=1.054–2.061, p=0.023), longer surgeries (OR=1.253, 95%CI=1.066–1.472, p=0.006), greater blood loss (OR=1.274, 95%CI=1.081–1.502, p=0.004), and occurrence of intra-operative complication (OR=2.203, 95%CI=1.498–3.241, p<0.001). Minimal-access-surgery was protective against minor-morbidity (OR=0.522, 95%CI=0.371–0.735, p≤0.001). Higher major-morbidity was associated with longer surgeries (OR=1.37, 95%CI=1.128–1.664, p=0.002), greater blood loss (OR=1.398, 95%CI=1.175–1.664, p≤0.001), and seniority of lead-surgeon with junior surgeons three times more likely to have a major-complication (OR=2.982, 95%CI=1.509–5.894, p=0.002). 50% versus 25% of all surgeries were performed by junior surgeons in LMICs/HICs respectively.Conclusion LMICs were associated with greater post-operative major-morbidity. Capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention.Disclosures None.