Preventable Surgical Harm in Gynecologic Oncology: Optimizing Quality and Patient Safety

Preventable medical adverse events are a leading cause of death in the USA. The most common adverse events include medication errors, perioperative complications, venous thromboembolism, infection, and readmission. Patients requiring care with a gynecologic oncologist are at increased risk for all of these adverse events, which are both clinically undesirable and now also represent targets for reduced hospital reimbursement. The goal of this review is to identify areas of preventable harm that occur in the perioperative period on a gynecologic oncology service and identify mechanisms to minimize harm.

Recognizing that gynecologic oncology surgical patients often present with advanced age, medical comorbidities, obesity, and diagnoses requiring radical procedures involving multi-organ resection, they are particularly at risk for perioperative complications, some preventable. Recent studies have examined evidence-based methods for minimizing many areas of preventable harm in gynecologic oncology surgical patients. Multiple studies have implemented bundles of care to successfully decrease surgical site infections. New data on risk of venous thromboembolism (VTE) specifically in gynecologic oncology patients guide recommendations for perioperative and extended VTE prophylaxis. Enhanced recovery after surgery programs explore a multitude of factors, many in a bundle format, to minimize overall perioperative complications and decrease length of stay. Additionally, new data are available on rates of hospital readmissions and risk factors for readmission.

There is already a wealth of information available regarding incidence of complications in gynecologic oncology surgical patients. Fortunately, there is a shift in the USA toward recognizing patient risk factors and implementing interventions to decrease the rate of preventable adverse events.