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Predictors of postoperative overall and severe complications after surgical treatment for endometrial cancer: The role of the fragility index
Author(s) -
Giannini Andrea,
Di Donato Violante,
Schiavi Michele C.,
May James,
Panici Pierluigi Benedetti,
Congiu Mario A.
Publication year - 2020
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.13020
Subject(s) - medicine , endometrial cancer , perioperative , odds ratio , confidence interval , logistic regression , intensive care unit , cancer , surgery
Objective To evaluate the predictive value of obesity, comorbidities, and fragility on overall and severe complication rate and survival among patients surgically treated for endometrial cancer. Methods Consecutive patients with endometrial cancer treated at the Royal Infirmary Hospital of Edinburgh from June 1, 2015, to June 30, 2017, were retrospectively enrolled in an observational study. Considering pre‐existing medical conditions, comorbidities, and complications, modified fragility index ( mFI ) was calculated. Logistic regression was used to evaluate predicting variables of overall (G1–G4) and severe (G3–G4) complication rate. Results One hundred patients were surgically treated for endometrial cancer. Elevated mFI >3 was related to a statistically higher access rate to the high dependency unit ( HDU ) or intensive care unit ( ITU ) (33.3% vs 6.6%, P =0.013). Overall, 31 women had postoperative complications. Using multivariate analysis, it was shown that undergoing laparotomy (odds ratio [ OR ] 7.06, 95% confidence interval [ CI ] 2.52–19.71; P <0.001) and having an mFI >3 ( OR 7.19, 95% CI 1.43–36.25; P =0.021) were independent predictors of overall complications (G1–G4). Moreover, only smoking ( OR 5.01, 95% CI 1.15–21.75; P =0.031) and mFI >3 ( OR 5.16, 95% CI 1.07–24.94; P =0.047) were independent factors for severe complications (G3–G4). Conclusion Modified fragility index was an important predictor of complications among patients treated for endometrial cancer and could be a useful tool for assisting clinicians in perioperative management.