Investigating the impact of asymptomatic ... - Gynecologic Oncology

Abstracts / Gynecologic Oncology 141 (2016) 2–208

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Conclusions: While referral guidelines focus on OB/GYN care paths, most OVCA patients had pelvic masses identified by other subspecialties. A significant number experienced inpatient or EM episodes where referral guidelines may not be well known. We have identified referral patterns and delay as potentially useful quality metrics of prereferral care.

Objectives: Surgical site infections (SSIs) remain a substantial cause of morbidity, prolonged hospitalization, and death in patients undergoing gynecologic cancer surgery, especially in those undergoing colorectal procedures. In addition, there is growing evidence that SSIs negatively impact oncologic outcomes. The objective of our study was to establish a risk prediction model for SSIs in patients undergoing complex gynecologic cancer surgery. Methods: We searched our institutional database for patients who underwent any COLO National Health Safety Network (NHSN) operative procedure category for a gynecologic malignancy as defined by ICD-9-CM codes from 2012 to 2015. Superficial, deep incisional and organ/space SSIs were captured as defined by the Centers for Disease Control and Prevention (CDC) within 30 days after surgery. Patient, preoperative, and intraoperative characteristics were assessed. A logistic regression model was built by performing backward stepwise variable selection based on Akaike Information Criterion (AIC). Results: We identified 365 patients who underwent COLO NHSN operative procedures. An SSI was detected in 95 patients (26.03%). Total blood loss, total/maximal relative value unit (RVU), the performance of a bowel resection, body mass index (BMI), preoperative low serum albumin levels, preoperatively elevated white blood cell (WBC) count, the performance of a lymphadenectomy, operative time, diabetes, and smoking were significantly associated with SSI. The optimal prediction model included the following variables: performance of a bowel resection, BMI, operative time, and preoperative serum albumin. A receiver operating characteristic curve was generated for the model, showing an AUC of 0.63 and an accuracy of 73.4%. Conclusions: We have developed and internally validated a risk prediction model for SSIs in patients undergoing complex gynecologic cancer surgery. Identifying patients at high risk for SSIs will allow for individualized perioperative interventions. This SSI risk prediction model will be used prospectively to stratify and evaluate SSI reduction initiatives at our institution.

doi:10.1016/j.ygyno.2016.04.430

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399 – Poster Investigating the impact of asymptomatic leukocytosis on postoperative outcomes in ovarian cancer J.B. Szender, K.S. Grzankowski, S.N. Akers, P.J. Frederick, S.B. Lele, K.O. Odunsi. Roswell Park Cancer Institute, Buffalo, NY, USA

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Table 1 Forty Non-Adherent Referral Patterns.

400 - Poster Risk prediction model for surgical site infections in patients undergoing gynecologic cancer surgery O. Zivanovic, J. Yan, S. Usiak, M. Lilavois, S. Ogden, M.M. Leitao, Y. Sonoda, D.A. Levine, D.S. Chi, N.R. Abu-Rustum. Memorial Sloan Kettering Cancer Center, New York, NY, USA

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Objectives: The purpose of this study is to identify the relationship between asymptomatic preoperative leukocytosis and postoperative complications in elective ovarian cancer surgery. Methods: We inspected the National Surgical Quality Improvement Program (NSQIP) participant use files from 2007 to 2013 for patients undergoing elective surgery for ovarian cancer. Patients were excluded if they had an infection present at the time of surgery (PATOS). We compared rates of death, NSQIP-tracked morbidities, infectious morbidity (surgical site infection, pneumonia, urinary tract infection, or sepsis), and return to the operating room. Patients were stratified based on leukocytosis (white blood cell [WBC] count N 11 × 109/L). Rates were adjusted for demographic and preoperative comorbidities. Relative risks were estimated using logistic regression. Results: We identified 7,535 patients who underwent surgery for ovarian cancer. Of these, 484 patients were excluded for emergency surgery or PATOS infections. Another 926 were excluded for no WBC value listed. Of 6,125 evaluable patients, 518 (8.5%) had a leukocytosis before surgery. The rate of complications in those patients was 440 per 1,000 surgeries, compared with 341 per 1,000 surgeries in patients who did not have leukocytosis (relative risk [RR] 1.29, 95% CI 1.16–1.43). Patients with leukocytosis also had increased risk of death (RR 2.41, 95% CI 1.34–4.32) and infectious morbidity (RR 1.34, 95% CI 1.05–1.70), but not return to the operating room (RR 1.23, 95% CI 0.82–1.85). After adjustment for extent of disease, prior chemotherapy treatment, and other preoperative factors, the risk of any NSQIP-tracked complication remained associated with leukocytosis, but infectious morbidity (RR 1.08, 95% CI 0.62–1.89) and death (RR 2.29, 95% CI 0.71–7.40) were no longer statistically significant. Conclusions: Patients going to surgery for ovarian cancer with preexisting leukocytosis are at increased risk of NSQIP-tracked complications in the 30 days after surgery, especially the risk of infectious morbidity. The interaction between the immune system and longterm ovarian cancer outcomes is well established. Paraneoplastic leukocytosis does not appear to increase the risk of postoperative death or return to the operating room within 30 days. doi:10.1016/j.ygyno.2016.04.431

doi:10.1016/j.ygyno.2016.04.432

401 – Poster Evaluation of smoking as a risk factor for adverse postoperative outcomes in endometrial cancer: A study of the NSQIP database J.B. Szender, P.C. Mayor, P.J. Frederick, K. Moysich, K.O. Odunsi, S.B. Lele. Roswell Park Cancer Institute, Buffalo, NY, USA Objectives: The purpose of this study is to determine the impact of smoking on surgical outcomes in endometrial cancer patients. Methods: We evaluated the National Surgical Quality Improvement Program (NSQIP) participant use files from 2007 to 2013 for patients undergoing elective surgery for endometrial cancer. Patients were classified as current smokers (regular smoking within 1 year of surgery) or nonsmokers. Other variables including preoperative comorbidities, such as hypertension, diabetes, and functional status; intraoperative variables, including operative time, extent of surgery (based on CPT code), and surgical approach; and postoperative complications, including death, return to the operating room (ROR), and infectious morbidity (surgical site infection [SSI], pneumonia [PNA], urinary tract infection [UTI], or sepsis), were recorded and compared using χ2 test of independence. Crude and adjusted relative risks (RRs) were estimated using logistic regression. P b .05 was used as a threshold of significance.