Introduction: The aim of this study is to provide
a comprehensive 5-year audit of patients undergoing laparotomy for suspected or
confirmed gynaecological malignancy to document the frequency and incidence of
adverse events and to investigate factors associated with shorter length of
stay and readmission to hospital. Methods: A 5-year surgical audit of the
period commencing 2008 and concluding 2012. All patients undergoing laparotomy
were included in the audit without exclusions. Approval was granted by the
local Ethics Review Committee. Results: Four hundred and twenty-seven patients
underwent laparotomy for suspected or confirmed gynaecological malignancy and
were managed by Fast Track Surgery (FTS) principles. Average age was 54.8 years
and average weight and BMI were 73.4 kg and 28.1 respectively. Ultimately 254
(59%) patients had confirmed malignancy. Average surgery duration was 2.36
hours and average estimated blood loss (EBL) at surgery was 262 mL. Median and
mean LOS was 3.0 and 3.5 days respectively with 125 (29%) patients discharged
on day 2. Overall transfusion rate was 5%. Other adverse events in decreasing
frequency were hospital readmission (3.7%), significant wound infection (3%)
and unplanned High Dependency Unit (HDU) admission (1.4%). All other adverse
events were uncommon with rates <0.5%. Factors associated with a short LOS
included year of surgery, age, performance status, malignant vs benign
pathology, the use of COX-2 inhibitors, operation time, incision type,
transfusion, and radical hysterectomy, at least 1 complication, if patients
tolerated early oral feeding (EOF). In multivariable analysis, year, age,
performance status, the use of COX-2 inhibitors, operation time and incision
type were significant. Factors associated with readmission included the use of
COX-2 inhibitors, operation time, performance of a lymph node dissection,
return to operating theatre, operation category at least 1 complication, and in
multivariable analysis lymph node dissection and the occurrence of at least 1
complication were significant. Conclusions: This 5-year audit is important in
establishing a contemporary incidence and the prevalence rate of serious
adverse events for patients with suspected or confirmed gynaecological cancer
undergoing laparotomy and managed by FTS principles. The community can be
reassured that the incidence of serious adverse events is low when managed by
FTS principles.