The impact of polypharmacy and comorbidities on surgical morbidity and mortality in patients with gynecological malignancies: Results of a prospective study in 237 patients.
e18255 Background: Physicians need to risk-stratify their patients preoperatively to adjust the radicality and the indication of surgery. So far, there are only retrospective and limiting data available. Aim of this study is to evaluate the predictive clinical characteristics such as polypharmacy and Charlson-Comorbidity Index (CCI) for postoperative complications in patients undergoing gynecologic cancer surgery. Methods: This is a prospective cohort study of patients undergoing gynecologic cancer surgery at a tertiary care academic center from October 2015 through January 2017. Surgical complications were graded using validated Clavien-Dindo criteria. Using logistic regression, we identified demographic and predictive clinical characteristics for postoperative complications. Results: Out of the 237 enrolled patients 41(17.3%) experienced a grade≥3b complication. Within 30 days of surgery, 9 (3.8%) patients has died. Charlson Comorbidity index (CCI)> 2(p<0.015, OR 2.33, 95% CI 1.18-4.61), polypharmacy (p<0.001, OR 3.40, 95% CI 1.63-7.10), ASA (p<0.0001, OR 2.98, 95% CI 1.65-5.38), BMI>25kg/m2 (p<0.001, OR 4.25, 95% CI 1.86-9.69), preoperative albumin<3.5 g/dl (p<0.009, OR 3.22, 95% CI 1.33-7.79) and potassium < 3.6 mmol/L (p=0.007, OR 5.11, 95% CI 1.55-16.81) were predictive for complications grade≥3b. A multivariable model included duration of surgery (p=0.012, OR 1.26, 95% CI 1.05-1.52), ASA (p=0.01, OR 2.60, 95% CI 1.20-5.60), preoperative albumin<3.5 g/dl (p=0.028, OR 3.37, 95% CI 1.14-10.00), BMI >25kg/m2 (p=0.009, OR 3.81, 95% CI 1.40-10.35) and potassium < 3.6 mmol/L (p=0.02, OR 3.69, 95% CI 1.20-11.38) was predictive of 30-day Morbidity and Mortality. Age (p=0.49, OR 0.89, 95% CI 0.95-1.02), CCI > 2(p=0.88, OR 1.06, 95% CI 0.42-2.69) and polypharmacy (p=0.65, OR 1.26, 95% CI 0.41-3.98) showed no association for postoperative complications. Conclusions: Only ASA, BMI, preoperative albumin and potassium are associated with severe postoperative complications in patients undergoing gynecologic cancer surgery. Subsequent studies should confirm this result to identify better frail cancer patients.