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Short-term surgical complications after radical hysterectomy - a nationwide cohort study

Wenzel, H. H. B., Kruitwagen, R. F. P. M., Nijman, H. W., Bekkers, R. L. M., Van Gorp, T., de Kroon, C. D., van Lonkhuijzen, L. R. C. W., Massuger, L. F. A. G., Smolders, R. G. V., van Trommel, N. E., Yigit, R., Zweemer, R. P. & van der Aa, M. A., Jul-2020, In : Acta Obstetricia et Gynecologica Scandinavica. 99, 7, p. 925-932 8 p.

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  • Short‐term surgical complications after radical hysterectomy—A nationwide cohort study

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DOI

  • Hans H B Wenzel
  • Roy F P M Kruitwagen
  • Hans W Nijman
  • Ruud L M Bekkers
  • Toon Van Gorp
  • Cornelis D de Kroon
  • Luc R C W van Lonkhuijzen
  • Leon F A G Massuger
  • Ramon G V Smolders
  • Nienke E van Trommel
  • Refika Yigit
  • Ronald P Zweemer
  • Maaike A van der Aa

INTRODUCTION: Centralisation has, among other aspects, been argued to have an impact on quality of care in terms of surgical morbidity. Next, monitoring quality of care is essential in identifying areas of improvement. This nationwide cohort study was conducted to determine the rate of short-term surgical complications and to evaluate its possible predictors in women with early-stage cervical cancer.

MATERIAL AND METHODS: Women diagnosed with early-stage cervical cancer, 2009 FIGO stages IB1 and IIA1, between 2015 and 2017 who underwent radical hysterectomy with pelvic lymphadenectomy in one of the nine specialised medical centres in the Netherlands, were identified from the Netherlands Cancer Registry. Women were excluded if primary treatment consisted of hysterectomy without parametrial dissection or radical trachelectomy. Women of whom radical hysterectomy has been aborted during procedure, were also excluded. Occurrence of intraoperative and postoperative complications and type of complications, developing within 30 days after surgery, were prospectively registered. Multivariable logistic regression analysis was used to identify predictors of surgical complications.

RESULTS: 472 women were selected of which 166 (35%) developed surgical complications within 30 days after radical hysterectomy. The most frequent complications were urinary retention with catheterisation in 73 women (15%) and excessive perioperative blood loss > 1000 mL in 50 women (11%). Open surgery (Odds Ratio (OR) 3.42; 95% CI [1.73 to 6.76]), chronic pulmonary disease (OR 3.14; [1.45 to 6.79]), vascular disease (OR 1.90; [1.07 to 3.38]) and medical centre (OR 2.83; [1.18 to 6.77]) emerged as independent predictors of the occurrence of complications. Body mass index (OR 0.94; [0.89 to 1.00]) was found as a negative predictor of urinary retention. Open surgery (OR 36.65; [7.10 to 189.12]) and body mass index (OR 1.15; [1.08 to 1.22]) were found to be independent predictors of excessive perioperative blood loss.

CONCLUSIONS: Short-term surgical complications develop in 35% of the women after radical hysterectomy for early-stage cervical cancer in the Netherlands, a nation with centralised surgical care. Comorbidities predict surgical complications and open surgery is associated with excessive perioperative blood loss.

Original languageEnglish
Pages (from-to)925-932
Number of pages8
JournalActa Obstetricia et Gynecologica Scandinavica
Volume99
Issue number7
Early online date18-Jan-2020
Publication statusPublished - Jul-2020

ID: 113433872