International Variations in Surgical Morbidity and Mortality Post Gynaecological Oncology Surgery: A Global Gynaecological Oncology Surgical Outcomes Collaborative Led Study (GO SOAR1)
Gynaecological malignancies affect women in low and middle income countries (LMICs) at disproportionately higher rates compared with high income countries (HICs) with little known about variations in access, quality, and outcomes in global cancer care. Our study aims to evaluate international variat...
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| Format: | Article |
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MDPI AG
2023-10-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/20/5001 |
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| author | Faiza Gaba Karen Ash Oleg Blyuss Nicolò Bizzarri Paul Kamfwa Allison Saiz David Cibula GO SOAR Collaborators |
| author_facet | Faiza Gaba Karen Ash Oleg Blyuss Nicolò Bizzarri Paul Kamfwa Allison Saiz David Cibula GO SOAR Collaborators |
| author_sort | Faiza Gaba |
| collection | DOAJ |
| description | Gynaecological malignancies affect women in low and middle income countries (LMICs) at disproportionately higher rates compared with high income countries (HICs) with little known about variations in access, quality, and outcomes in global cancer care. Our study aims to evaluate international variation in post-operative morbidity and mortality following gynaecological oncology surgery between HIC and LMIC settings. Study design consisted of a multicentre, international prospective cohort study of women undergoing surgery for gynaecological malignancies (NCT04579861). Multilevel logistic regression determined relationships within three-level nested-models of patients within hospitals/countries. We enrolled 1820 patients from 73 hospitals in 27 countries. Minor morbidity (Clavien–Dindo I–II) was 26.5% (178/672) and 26.5% (267/1009), whilst major morbidity (Clavien–Dindo III–V) was 8.2% (55/672) and 7% (71/1009) for LMICs/HICs, respectively. Higher minor morbidity was associated with pre-operative mechanical bowel preparation (OR = 1.474, 95%CI = 1.054–2.061, <i>p</i> = 0.023), longer surgeries (OR = 1.253, 95%CI = 1.066–1.472, <i>p</i> = 0.006), greater blood loss (OR = 1.274, 95%CI = 1.081–1.502, <i>p</i> = 0.004). Higher major morbidity was associated with longer surgeries (OR = 1.37, 95%CI = 1.128–1.664, <i>p</i> = 0.002), greater blood loss (OR = 1.398, 95%CI = 1.175–1.664, <i>p</i> ≤ 0.001), and seniority of lead surgeon, with junior surgeons three times more likely to have a major complication (OR = 2.982, 95%CI = 1.509–5.894, <i>p</i> = 0.002). Of all surgeries, 50% versus 25% were performed by junior surgeons in LMICs/HICs, respectively. We conclude that LMICs and HICs were associated with similar post-operative major morbidity. Capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. |
| first_indexed | 2024-03-10T21:22:38Z |
| format | Article |
| id | doaj.art-82c27197de1542b188c3bb9546741f4a |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T21:22:38Z |
| publishDate | 2023-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-82c27197de1542b188c3bb9546741f4a2023-11-19T15:59:09ZengMDPI AGCancers2072-66942023-10-011520500110.3390/cancers15205001International Variations in Surgical Morbidity and Mortality Post Gynaecological Oncology Surgery: A Global Gynaecological Oncology Surgical Outcomes Collaborative Led Study (GO SOAR1)Faiza Gaba0Karen Ash1Oleg Blyuss2Nicolò Bizzarri3Paul Kamfwa4Allison Saiz5David Cibula6GO SOAR CollaboratorsDepartment of Gynaecological Oncology, Royal London Hospital, Barts Health NHS Trust, London E1 1FR, UKAberdeen Royal Infirmary, NHS Grampian, Aberdeen AB25 2ZN, UKWolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UKUOC Ginecologia Oncologica, Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, ItalyCancer Diseases Hospital, Lusaka 10101, ZambiaNorthwestern University in Chicago, Chicago, IL 60611, USADepartment of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital, 121 08 Prague, Czech RepublicGynaecological malignancies affect women in low and middle income countries (LMICs) at disproportionately higher rates compared with high income countries (HICs) with little known about variations in access, quality, and outcomes in global cancer care. Our study aims to evaluate international variation in post-operative morbidity and mortality following gynaecological oncology surgery between HIC and LMIC settings. Study design consisted of a multicentre, international prospective cohort study of women undergoing surgery for gynaecological malignancies (NCT04579861). Multilevel logistic regression determined relationships within three-level nested-models of patients within hospitals/countries. We enrolled 1820 patients from 73 hospitals in 27 countries. Minor morbidity (Clavien–Dindo I–II) was 26.5% (178/672) and 26.5% (267/1009), whilst major morbidity (Clavien–Dindo III–V) was 8.2% (55/672) and 7% (71/1009) for LMICs/HICs, respectively. Higher minor morbidity was associated with pre-operative mechanical bowel preparation (OR = 1.474, 95%CI = 1.054–2.061, <i>p</i> = 0.023), longer surgeries (OR = 1.253, 95%CI = 1.066–1.472, <i>p</i> = 0.006), greater blood loss (OR = 1.274, 95%CI = 1.081–1.502, <i>p</i> = 0.004). Higher major morbidity was associated with longer surgeries (OR = 1.37, 95%CI = 1.128–1.664, <i>p</i> = 0.002), greater blood loss (OR = 1.398, 95%CI = 1.175–1.664, <i>p</i> ≤ 0.001), and seniority of lead surgeon, with junior surgeons three times more likely to have a major complication (OR = 2.982, 95%CI = 1.509–5.894, <i>p</i> = 0.002). Of all surgeries, 50% versus 25% were performed by junior surgeons in LMICs/HICs, respectively. We conclude that LMICs and HICs were associated with similar post-operative major morbidity. Capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention.https://www.mdpi.com/2072-6694/15/20/5001surgerygynaecological oncologymorbiditymortalitycollaborative research |
| spellingShingle | Faiza Gaba Karen Ash Oleg Blyuss Nicolò Bizzarri Paul Kamfwa Allison Saiz David Cibula GO SOAR Collaborators International Variations in Surgical Morbidity and Mortality Post Gynaecological Oncology Surgery: A Global Gynaecological Oncology Surgical Outcomes Collaborative Led Study (GO SOAR1) Cancers surgery gynaecological oncology morbidity mortality collaborative research |
| title | International Variations in Surgical Morbidity and Mortality Post Gynaecological Oncology Surgery: A Global Gynaecological Oncology Surgical Outcomes Collaborative Led Study (GO SOAR1) |
| title_full | International Variations in Surgical Morbidity and Mortality Post Gynaecological Oncology Surgery: A Global Gynaecological Oncology Surgical Outcomes Collaborative Led Study (GO SOAR1) |
| title_fullStr | International Variations in Surgical Morbidity and Mortality Post Gynaecological Oncology Surgery: A Global Gynaecological Oncology Surgical Outcomes Collaborative Led Study (GO SOAR1) |
| title_full_unstemmed | International Variations in Surgical Morbidity and Mortality Post Gynaecological Oncology Surgery: A Global Gynaecological Oncology Surgical Outcomes Collaborative Led Study (GO SOAR1) |
| title_short | International Variations in Surgical Morbidity and Mortality Post Gynaecological Oncology Surgery: A Global Gynaecological Oncology Surgical Outcomes Collaborative Led Study (GO SOAR1) |
| title_sort | international variations in surgical morbidity and mortality post gynaecological oncology surgery a global gynaecological oncology surgical outcomes collaborative led study go soar1 |
| topic | surgery gynaecological oncology morbidity mortality collaborative research |
| url | https://www.mdpi.com/2072-6694/15/20/5001 |
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