e16510 Background: Minimally invasive surgery (MIS) has gained increasing acceptance as an alternative to standard laparotomy in gynecologic cancer, but surgical approach with respect to non-epithelial ovarian cancers has not been extensively studied. We compared perioperative and long-term outcomes of women with ovarian granulosa cell tumors (GCTs) who underwent laparoscopy versus laparotomy. Methods: Inclusion criteria were surgical treatment and stage I-IV GCTs. Abstracted data included: surgical modality (laparoscopic vs open), demographics, operative details, and disease course. Survival was analyzed using the Kaplan-Meier method and Cox model. The chi square test of association, Wilcoxon rank-sum test and t-test were used for the group comparisons. Results: 166 women with ovarian GCTs were identified of which 160 were evaluable; 32 and 128 underwent laparoscopy and laparotomy, respectively. The overall survival (OS) and disease-free survival (DFS) were not significantly different between those treated with laparoscopy and laparotomy (OS 92% vs 77%, p=.42; DFS 55 vs 47%, p=.79). Advanced age at diagnosis was associated with decreased OS (HR 1.04 95% CI [1.01-1.07], p=.013). MIS was associated with lower EBL (106 vs 430cc, p<.001), earlier discharge (1.5 vs 4.2 days, p<.001), smaller tumor size (7.9 vs 15.7cm, p<.001), and fewer complications (3.4 vs 19.2%, p=.039). There was no difference in age (p=.20), race (p=.37), BMI (p=.89), pre-operative Inhibin B (263 vs 786 pg/mL, p=.13), stage (p=.15), and intra-operative cyst rupture (p=.36). Conclusions: Our findings suggest that MIS is reasonable for women with GCT with similar survival outcomes compared to laparotomy. Laparoscopy was associated with lower EBL, earlier discharge, and fewer complications.
Hospital readmission rates are an important measure of quality care and have recently been tied to reimbursement. This study seeks to identify the risk factors for postoperative readmission in patients treated by a gynecologic oncology service.A 7-year retrospective review (2007-2013) of all patients operated on by the University of Virginia gynecologic oncology service who were readmitted within 30 days of discharge was performed. Abstracted data included demographics, dates of surgery, operative details, cancer history, and relevant medical history. The readmitted patients (n = 166) were compared with randomly selected controls (n = 168) from the same service in a matching time frame and analyzed using univariate and multivariate models.In the study period, 2993 operations were performed. One hundred sixty-six unique patients (5.5%) were readmitted within 30 days of discharge from their operative procedure. On multivariate analysis, the factors that were associated with a higher risk of readmission were a history of psychiatric disease, postoperative complication, type of insurance, surgical modality, and lysis of adhesions at the time of surgery. The most common readmission diagnoses were infection (44%), nausea/vomiting (28%), thrombosis (6%), bowel leak (4%), and bleeding (4%).Postoperative readmissions are a common problem and are increasingly important as a measure of quality. Although patients were generally admitted for infections or gastrointestinal complaints, we also found that individual factors such as mental health and socioeconomic status also contributed. Our data suggest that we can preoperatively identify high-risk individuals for whom extra resources can be directed postoperatively to avoid unnecessary readmissions.
e17529 Background: Venous thromboembolism (VTE) is a significant risk for women with gynecologic cancer. As the risk of VTE is increased along with morbidity and mortality in the gynecologic oncologic population undergoing major surgery, the focus of prophylaxis has shifted to also providing pre-operative prophylactic anticoagulation. Yet, there remains controversy in the optimal prophylactic regimen for the major surgical gynecologic cancer patient. The objective of this study was to define the incidence of VTE in gynecologic cancer patients prior to and after the institutional implementation of pre-operative heparin in the VTE prophylaxis regimen. Methods: A retrospective cohort study was performed in patients with gynecologic cancer who underwent a major surgical procedure from January 2010 to December 2016 at a single institution. The incidence of post-operative VTE was compared between patients who received post-operative mechanical and chemical prophylaxis and those who received a single dose of pre-operative heparin in addition starting in 2015. Factors including estimated surgical blood loss, amount and location of disease at time of surgery, and route of surgery were examined in those diagnosed with a VTE post-operatively. Results: Of the 609 surgical patients with gynecologic cancer prior to the initiation of a single dose of preoperative heparin, 42 (6.90%) were diagnosed with a post-operative VTE. After initiation of pre-operative heparin, 17 (3.27%) of 520 patients experienced VTE postoperatively. There was a significant difference between the incidence of VTE after the practice change (p < 0.006, 95% CI 1.03-6.23%). Surgical blood loss was similar in both groups. Those diagnosed with a VTE tended to have a heavy burden of disease at time of surgery and underwent laparotomy. Conclusions: A significant decrease in the incidence of VTE in patients with gynecologic malignancy undergoing surgery was seen with the initiation of a single dose of pre-operative heparin. This shift in the standard of care has had a meaningful impact at an institutional level and has potential to be impactful at a national level.
