Epidemiologic profile of benign versus oncologic gynecology populations: similar procedures, different patients

Objective: We sought to compare preoperative comorbidities in patients undergoing benign versus oncologic gynecologic surgeries. Methods: All cases of benign and malignant gynecologic surgeries in the National Surgery Quality Improvement Program (NSQIP) database between 2006-2012 were identified. Gynecologic cancers were grouped by site: uterus, ovary, cervix, and “other” including labia, vulva, vagina, pelvis, and retroperitoneum. Preoperative comorbidities were captured. Descriptive analyses were performed. 94,935 patients underwent gynecologic surgeries: 87.8% benign and 12.2% oncologic. The prevalence of cardiovascular disease, pulmonary disease, and neurologic disease differed between benign and oncologic groups (p < 0.001). In uterine, ovarian and other cancers, greater than 40% of patients had one or more comorbidities and > 5% had 2 or more, (p < 0.001). Gynecologic oncology patients were significantly older, had higher BMI, greater proportion black, and had more comorbidities than patients undergoing benign gynecologic surgery. Comorbidity profiles also differed significantly by type of gynecologic cancer. Preoperative and postoperative optimization, risk assessments, and appropriate reimbursement coverage should account for these baseline differences.

Comorbidity profile; Gynecologic cancer; Reimbursement

[1] US department of health and human services. Strategic Plan Fiscal Years 2010 ­ 2015.2010. Accessed December 15, 2018.

[2] Cohn D.E., Leitao M., Levenback C., Berkowitz R., Roman L., Lucci J., et al.: “Reporting of quality measures in gynecologic oncology programs at Prospective Payment System (PPS)­Exempt Cancer Hospitals: an early glimpse into a challenging initiative”. Gynecol. Oncol., 2013, 130, 403.

[3] Iyer R., Gentry­Maharaj A., Nordin A., Burnell M., Liston R., Man­ chanda R., et al.: “Predictors of complications in gynaecological on­ cological surgery: a prospective multicentre study (UKGOSOC­UK gynaecological oncology surgical outcomes and complications)”. Br. J. Cancer., 2014, 112, 475.

[4] Mahdi H., Jernigan A.M., Aljebori Q., Lockhart D., Moslemi­ Kebria M.: “The impact of obesity on the 30­day morbidity and mortality after surgery for endometrial cancer”. J. Miniz. Invasive. Gynecol., 2014, 22, 94.

[5] Suidan R.S., Leita M.M., Jr., Zivanovi O., Gardner G.J., Long Roche K.C., Sonoda Y., et al.: “Predictive value of the Age­ Adjusted Charlson Comorbidity Index on perioperative complica­ tions and survival in patients undergoing primary debulking surgery for advanced epithelial ovarian cancer”. Gynecol. Oncol., 2015, 138, 246.

[6] Piccirillo J.F., Tierney R.M., Costas I., Grove L., Spitznagel E.L.: “Prognostic importance of comorbidity in a hospital­based cancer registry”. JAMA., 2004, 291, 2441.

[7] Szender J.B., Frederick P.J., Eng K.H., Akers S.N., Lele S.B., Odunsi K.: “Evaluation of the National Surgical Quality Improve­ ment Program Universal Surgical Risk Calculator for a gynecologic oncology service”. Int. J. Gynecol. Cancer., 2015, 25, 512.

[8] Teoh D., Halloway R.N., Heim J., Vogel R.I., Rivard C.: “Evalua­ tion of the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator in Gynecologic On­ cology Patients Undergoing Minimally Invasive Surgery”. J. Minim. Invasive .Gynecol., 2016, 24, 48.

[9] Rivard C., Nahum R., Slagle E., Duininck M., Isaksson Vogel R., Teoh D.: “Evaluation of the performance of the ACS NSQIP sur­gical risk calculator in gynecologic oncology patients undergoing laparotomy”. Gynecol. Oncol., 2016, 141, 281.

[10] Cory L., Latif N., Brensinger C., Zhang X., Giuntoli R.L., Burger R.A., et al.: “Readmission After Gynecologic Surgery: A Compar­ ison of Procedures for Benign and Malignant Indications”. Obstet. Gynecol., 2017, 130, 285.

[11] Dessources K., Hou J.Y., Tergas A.I., Burke W.M., Ananth C.V., Prendergast E., et al.: “Factors associated with 30­day hospital read­ mission after hysterectomy”. Obstet. Gynecol., 2015, 125, 461.

[12] Bilimoria K.Y., Liu Y., Paruch J.L., Zhou L., Kmiecik T.E., Ko C.Y., et al.: “Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons”. J. Am. Coll. Surg., 2013, 217, 833.

[13] Edwards B.K., Noone A.M., Mariotto A.B., Simard E.P., Boscoe F.P., Henley S.J., et al.: “Annual Report to the Nation on the status of cancer, 1975­2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer”. Cancer., 2014, 120, 1290.

[14] Cho H., Mariotto A.B., Mann B.S., Klabunde C.N., Feuer E.J.: “Assessing non­cancer­related health status of US cancer patients: other­cause survival and comorbidity prevalence”. Am. J. Epi­ demiol., 2013, 178, 339.

[15] Aletti G.D., Santillan A., Eisenhauer E.L., Hu J., Aletti G., Po­ dratz K.C., et al.: “A new frontier for quality of care in gyneco­ logic oncology surgery: multi­institutional assessment of short­term outcomes for ovarian cancer using a risk­adjusted model”. Gynecol. Oncol., 2007, 107, 99.

[16] Elshaikh M.A., Vance S., Kamal M., Burmeister C., Hanna R.K., Rasool N., et al.: “Influence of comorbidity on the risk of death: a single institution study of 1132 women with early­stage uterine cancer”. Am. J. Clin. Oncol., 2014.

[17] Barber E.L., Rutstein S., Miller W.C., Gehrig P.A.: “A preoperative personalized risk assessment calculator for elderly ovarian cancer patients undergoing primary cytoreductive surgery”. Gynecol. On­ col., 2015, 139, 401.

[18] Kohut A., Orfanelli T., Poggio J.L., Gibbon D., Buckley De Meritens A., Richard S., et al.: “Morbidity and mortality risk assess­ ment in gynecologic oncology surgery using the american college of surgeons national surgical quality improvement program database”. Int. J. Gynecol. Cancer., 2018, 28, 840.

[19] Mansmann U., Rieger A., Strahwald B., Crispin A.: “Risk calculators­methods, development, implementation, and valida­ tion”. Int. J. Colorectal. Dis., 2016, 31, 1111.

[20] Cohn D.E., Ko E., Meyer L.A., Wright J.D., Temkin S.M., Foote J., et al.: “The ”value” of value in gynecologic oncology practice in the United States: Society of Gynecologic Oncology evidence­ based review and recommendations”. Gynecol. Oncol., 2017, 145, 185.